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. 2018 Apr-Jun;40(2):151-161.
doi: 10.1590/2175-8239-JBN-3865. Epub 2018 Jun 4.

The influence of clinical, environmental, and socioeconomic factors on five-year patient survival after kidney transplantation

[Article in English, Portuguese]
Priscila Ruppel  1 , Claudia R Felipe  1 , Jose O Medina-Pestana  1 , Liliane Lumi Hiramoto  1 , Laila Viana  1 , Alexandra Ferreira  1 , Wilson Aguiar  1 , Mayara Ivani  1 , Adrieli Bessa  1 , Marina Cristelli  1 , Melissa Gaspar  1 , Helio Tedesco-Silva Jr  1
Affiliations

The influence of clinical, environmental, and socioeconomic factors on five-year patient survival after kidney transplantation

[Article in English, Portuguese]
Priscila Ruppel et al. J Bras Nefrol. 2018 Apr-Jun.

Abstract
in English, Portuguese

Introduction: The risk of death after kidney transplant is associated with the age of the recipient, presence of comorbidities, socioeconomic status, local environmental characteristics and access to health care.

Objective: To investigate the causes and risk factors associated with death during the first 5 years after kidney transplantation.

Methods: This was a single-center, retrospective, matched case-control study.

Results: Using a consecutive cohort of 1,873 kidney transplant recipients from January 1st 2007 to December 31st 2009, there were 162 deaths (case group), corresponding to 5-year patient survival of 91.4%. Of these deaths, 25% occurred during the first 3 months after transplant. The most prevalent cause of death was infectious (53%) followed by cardiovascular (24%). Risk factors associated with death were history of diabetes, dialysis type and time, unemployment, delayed graft function, number of visits to center, number of hospitalizations, and duration of hospital stay. After multivariate analysis, only time on dialysis, number of visits to center, and days in hospital were still associated with death. Patients who died had a non-significant higher number of treated acute rejection episodes (38% vs. 29%, p = 0.078), higher mean number of adverse events per patient (5.1 ± 3.8 vs. 3.8 ± 2.9, p = 0.194), and lower mean eGFR at 3 months (50.8 ± 25.1 vs. 56.7 ± 20.7, p = 0.137) and 48 months (45.9 ± 23.8 vs. 58.5 ± 20.2, p = 0.368).

Conclusion: This analysis confirmed that in this population, infection is the leading cause of mortality over the first 5 years after kidney transplantation. Several demographic and socioeconomic risk factors were associated with death, most of which are not readily modifiable.

Introdução:: O risco de óbito após transplante renal está associado à idade do receptor, presença de comorbidades, condição socioeconômica, às características ambientais locais e ao acesso a serviços de atenção à saúde.

Objetivo:: Investigar as causas e fatores de risco associados ao óbito nos primeiros cinco anos após o transplante renal.

Métodos:: Este é um estudo unicêntrico retrospectivo com pareamento dos grupos caso e controle.

Resultados:: Em uma coorte consecutiva de 1.873 receptores de transplante renal atendidos de 1/1/2007 a 31/12/2009 foram registrados 162 óbitos (grupo caso), correspondendo a uma taxa de sobrevida após cinco anos de 91,4%. Dos óbitos registrados, 25% ocorreram nos primeiros três meses após o transplante. A causa de óbito mais prevalente foi infecção (53%), seguida de doença cardiovascular (24%). Os fatores de risco associados a mortalidade foram histórico de diabetes, tipo e tempo em diálise, desemprego, função tardia do enxerto, número de consultas, número de hospitalizações e tempo de internação hospitalar. Após análise multivariada, apenas o tempo em diálise, o número de consultas e dias de internação permaneceram associados a mortalidade. Os pacientes que foram a óbito tiveram um número não significativamente maior de tratamentos de episódios de rejeição aguda (38% vs. 29%; p = 0,078), maior número médio de eventos adversos por paciente (5,1 ± 3,8 vs. 3,8 ± 2,9; p = 0,194) e TFGe média mais baixa aos três meses (50,8 ± 25,1 vs. 56,7 ± 20,7; p = 0,137) e 48 meses (45,9 ± 23,8 vs. 58,5 ± 20,2; p = 0,368).

Conclusão:: A presente análise confirmou que nessa população, a infecção foi a principal causa de mortalidade nos primeiros cinco anos após transplante renal. Vários fatores de risco demográficos e socioeconômicos foram associados a mortalidade, a maioria não prontamente modificável.

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Figures

Figure 1
Figure 1. Causes of adverse events according to CTCAE. BLSD: blood and lymphatic system disorders; CD: Cardiac disorders; ED: endocrine disorders; GD: gastrointestinal disorders; GDASC: general disorders and administration site condition; IID: infections and infestation disorders; IPPC: injury, poisoning and procedural complications; I: investigation; MND: metabolism and nutrition disorders; MCTD: musculoskeletal and connective tissue disorder; NBMU: neoplasms benign, malignant and unspecified (including cysts and polyps); NS: nervous system; RUD: renal and urinary disorders; RTMD: respiratory, thoracic and mediastinal disorders; VD: vascular disorder; HD: hepatobiliary disorders; PD: psychiatric disorders.
See this image and copyright information in PMC

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