Análise de uma coorte de pacientes transplantados renais acompanhados no núcleo interdisciplinar de estudos e pesquisas em nefrologia da Universidade Federal de Juiz de Fora (NIEPEN-UFJF)

Abstract

Since the first successful kidney transplant, performance data have been monitored, measured and reported in order to guide transplant activity worldwide. In this paper, we evaluated clinical data from medical records of all kidney transplant recipients followed at the Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia of the Federal University of Juiz de Fora (NIEPEN-UFJF), from January 2002 to December 2012. This is a retrospective cohort study, first conceived from periodical data feeding of the Brazilian National Transplant Control Database (CNTx). The main goal was to describe patient and graft survival, as well as clinical and demographic variables affecting them, in the setting of a low activity transplant center. We studied 162 patients, with a mean age of 44 ± 11.5 years, and 92% had a living donor. Patient, graft and death-censored graft survival rates were assessed by Kaplan-Meier analysis, and their association with the studied risk factors was assessed through log-rank test, or Cox model, as suitable. Patient survival at 1, 3 and 5 years was 88.6%, 86% and 82.9%, respectively. Graft survival was 86.9%, 83% and 77%, and death-censored graft survival was 98.1%, 96.6% and 92.9% for the aforementioned time points. Most grafts were lost due to patient death caused by infections, which mainly occurred within the first posttransplant year. After statistical adjustments, we observed that age over 42 years (HHR 3.94, CI 1.39 to 11.13), deceased donor (HHR 11.41, CI 1.2 to 108.35) and schooling time between 8-11 years were independently associated with graft loss. In summary, despite a high early mortality rate, patient and graft survival rates we observed are similar to those described in large databases. We believe that improvements in long-term posttransplant care are a key issue to improve survival rates, especially in low-activity transplant centers, which in Brazil account for roughly 30% of transplant activity, but also represent a great potential source of growth in number of transplants in years to come.