Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival
Autor(a) principal: | |
---|---|
Data de Publicação: | 2014 |
Outros Autores: | , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692014000100006 |
Resumo: | Objective: To determine risk factors for acute rejection in the first 6 months post- transplant and their effect on death-censored graft and patient survival in the 990-1999 and 2000-2009 periods. Patients and Methods: Retrospective analysis of acute rejection episodes was performed separately in two periods: 1990-1999 and 2000-2009. Multivariate logistic regression analysis was performed in order to identify risk factors for acute rejection. Death-censored graft and patient survival comparison between patients with or without acute rejection occurrence was performed by Kaplan-Meier analysis. Multivariate Cox regression analysis identified independent predictors for death-censored graft and patient survival, assuming the following model: acute rejection, patients age (< 40 vs. ≥ 40 years) and gender, time on haemodialysis / peritoneal dialysis (< 36 vs. ≥ 36 months), live vs. deceased donor (only after the year 2000), HLA mismatches (0-3 vs. 4-6), PRA (≤ 15 vs. > 15%), number of previous kidney transplants (< 2 vs. ≥ 2), status of hepatitis B/C, donor´s age (< 38 vs. ≥ 38 years) and gender, delayed graft function (DGF), ATG use in induction immunosuppression (IS), MMF or Tacrolimus use in induction / maintenance IS (after 2000). Results: A total of 1299 kidney transplants were analyzed. Acute rejection was more frequently diagnosed in the 1990s (26.2% vs. 11.1%, p < 0.001). Over this period, ATG non-use (OR 1.88, p = 0.025) and patients age < 40 years (OR 2.39, p = 0.001) were risk factors for AR while, after 2000, DGF (OR 1.895, p = 0.046) and PRA > 15% (OR 3.519, p = 0.001) were identified. Five years death-censored graft survival was lower in AR cases in the 1990s (81% vs. 94%, p < 0.001) and after 2000 (81% vs. 91%, log rank p = 0.004). Independent predictors for worse death-censored graft survival in 1990-1999 patients were AR (HR 2,436, p < 0.001), patient´s age < 40 years (HR 1.984, p = 0.002) and donor´s age ≥ 38 years (HR 1.961, p = 0.002), while after 2000, DGF (HR 3.247, p < 0.001) and donor´s age ≥ 38 years (HR 2.32, p = 0.017) were identified. No difference was found at five-year patient survival in both groups. Only hepatitis B/C (HR 1.714, p = 0.023) was identified as an independent predictor for patient death in the 1990-1999 period, while after 2000, retransplantation (HR 2,718, p = 0.049) and AR (HR 2,619, p = 0.023) were determinant. Conclusion: After the year 2000, AR was no longer an independent predictor for poor graft survival. Inversely, AR began to play a deleterious effect on patient survival. Advances on immunosuppressive drugs allowed the increase of kidney transplant on hypersensitized patients, with improvement of graft survival in those patients but also with a possible deleterious effect on patient survival. |
id |
RCAP_0e6762ad917d439249875f15fce0c261 |
---|---|
oai_identifier_str |
oai:scielo:S0872-01692014000100006 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survivalacute rejectionkidney transplantpredictorssurvivalObjective: To determine risk factors for acute rejection in the first 6 months post- transplant and their effect on death-censored graft and patient survival in the 990-1999 and 2000-2009 periods. Patients and Methods: Retrospective analysis of acute rejection episodes was performed separately in two periods: 1990-1999 and 2000-2009. Multivariate logistic regression analysis was performed in order to identify risk factors for acute rejection. Death-censored graft and patient survival comparison between patients with or without acute rejection occurrence was performed by Kaplan-Meier analysis. Multivariate Cox regression analysis identified independent predictors for death-censored graft and patient survival, assuming the following model: acute rejection, patients age (< 40 vs. ≥ 40 years) and gender, time on haemodialysis / peritoneal dialysis (< 36 vs. ≥ 36 months), live vs. deceased donor (only after the year 2000), HLA mismatches (0-3 vs. 4-6), PRA (≤ 15 vs. > 15%), number of previous kidney transplants (< 2 vs. ≥ 2), status of hepatitis B/C, donor´s age (< 38 vs. ≥ 38 years) and gender, delayed graft function (DGF), ATG use in induction immunosuppression (IS), MMF or Tacrolimus use in induction / maintenance IS (after 2000). Results: A total of 1299 kidney transplants were analyzed. Acute rejection was more frequently diagnosed in the 1990s (26.2% vs. 11.1%, p < 0.001). Over this period, ATG non-use (OR 1.88, p = 0.025) and patients age < 40 years (OR 2.39, p = 0.001) were risk factors for AR while, after 2000, DGF (OR 1.895, p = 0.046) and PRA > 15% (OR 3.519, p = 0.001) were identified. Five years death-censored graft survival was lower in AR cases in the 1990s (81% vs. 94%, p < 0.001) and after 2000 (81% vs. 91%, log rank p = 0.004). Independent predictors for worse death-censored graft survival in 1990-1999 patients were AR (HR 2,436, p < 0.001), patient´s age < 40 years (HR 1.984, p = 0.002) and donor´s age ≥ 38 years (HR 1.961, p = 0.002), while after 2000, DGF (HR 3.247, p < 0.001) and donor´s age ≥ 38 years (HR 2.32, p = 0.017) were identified. No difference was found at five-year patient survival in both groups. Only hepatitis B/C (HR 1.714, p = 0.023) was identified as an independent predictor for patient death in the 1990-1999 period, while after 2000, retransplantation (HR 2,718, p = 0.049) and AR (HR 2,619, p = 0.023) were determinant. Conclusion: After the year 2000, AR was no longer an independent predictor for poor graft survival. Inversely, AR began to play a deleterious effect on patient survival. Advances on immunosuppressive drugs allowed the increase of kidney transplant on hypersensitized patients, with improvement of graft survival in those patients but also with a possible deleterious effect on patient survival.Sociedade Portuguesa de Nefrologia2014-03-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692014000100006Portuguese Journal of Nephrology & Hypertension v.28 n.1 2014reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692014000100006Costa,RuiMalheiro,JorgeSantos,ClaraFonseca,IsabelMartins,La SaletePedroso,SofiaAlmeida,ManuelaDias,LeonidioCastro-Henriques,AntonioMorgado,TeresaCabrita,Antonioinfo:eu-repo/semantics/openAccess2024-02-06T17:04:44Zoai:scielo:S0872-01692014000100006Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:18:51.890353Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival |
title |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival |
spellingShingle |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival Costa,Rui acute rejection kidney transplant predictors survival |
title_short |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival |
title_full |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival |
title_fullStr |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival |
title_full_unstemmed |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival |
title_sort |
Acute rejection during the first six-months after transplantation: temporal trends regarding risk factors and effects on graft and patient survival |
author |
Costa,Rui |
author_facet |
Costa,Rui Malheiro,Jorge Santos,Clara Fonseca,Isabel Martins,La Salete Pedroso,Sofia Almeida,Manuela Dias,Leonidio Castro-Henriques,Antonio Morgado,Teresa Cabrita,Antonio |
author_role |
author |
author2 |
Malheiro,Jorge Santos,Clara Fonseca,Isabel Martins,La Salete Pedroso,Sofia Almeida,Manuela Dias,Leonidio Castro-Henriques,Antonio Morgado,Teresa Cabrita,Antonio |
author2_role |
author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Costa,Rui Malheiro,Jorge Santos,Clara Fonseca,Isabel Martins,La Salete Pedroso,Sofia Almeida,Manuela Dias,Leonidio Castro-Henriques,Antonio Morgado,Teresa Cabrita,Antonio |
dc.subject.por.fl_str_mv |
acute rejection kidney transplant predictors survival |
topic |
acute rejection kidney transplant predictors survival |
description |
Objective: To determine risk factors for acute rejection in the first 6 months post- transplant and their effect on death-censored graft and patient survival in the 990-1999 and 2000-2009 periods. Patients and Methods: Retrospective analysis of acute rejection episodes was performed separately in two periods: 1990-1999 and 2000-2009. Multivariate logistic regression analysis was performed in order to identify risk factors for acute rejection. Death-censored graft and patient survival comparison between patients with or without acute rejection occurrence was performed by Kaplan-Meier analysis. Multivariate Cox regression analysis identified independent predictors for death-censored graft and patient survival, assuming the following model: acute rejection, patients age (< 40 vs. ≥ 40 years) and gender, time on haemodialysis / peritoneal dialysis (< 36 vs. ≥ 36 months), live vs. deceased donor (only after the year 2000), HLA mismatches (0-3 vs. 4-6), PRA (≤ 15 vs. > 15%), number of previous kidney transplants (< 2 vs. ≥ 2), status of hepatitis B/C, donor´s age (< 38 vs. ≥ 38 years) and gender, delayed graft function (DGF), ATG use in induction immunosuppression (IS), MMF or Tacrolimus use in induction / maintenance IS (after 2000). Results: A total of 1299 kidney transplants were analyzed. Acute rejection was more frequently diagnosed in the 1990s (26.2% vs. 11.1%, p < 0.001). Over this period, ATG non-use (OR 1.88, p = 0.025) and patients age < 40 years (OR 2.39, p = 0.001) were risk factors for AR while, after 2000, DGF (OR 1.895, p = 0.046) and PRA > 15% (OR 3.519, p = 0.001) were identified. Five years death-censored graft survival was lower in AR cases in the 1990s (81% vs. 94%, p < 0.001) and after 2000 (81% vs. 91%, log rank p = 0.004). Independent predictors for worse death-censored graft survival in 1990-1999 patients were AR (HR 2,436, p < 0.001), patient´s age < 40 years (HR 1.984, p = 0.002) and donor´s age ≥ 38 years (HR 1.961, p = 0.002), while after 2000, DGF (HR 3.247, p < 0.001) and donor´s age ≥ 38 years (HR 2.32, p = 0.017) were identified. No difference was found at five-year patient survival in both groups. Only hepatitis B/C (HR 1.714, p = 0.023) was identified as an independent predictor for patient death in the 1990-1999 period, while after 2000, retransplantation (HR 2,718, p = 0.049) and AR (HR 2,619, p = 0.023) were determinant. Conclusion: After the year 2000, AR was no longer an independent predictor for poor graft survival. Inversely, AR began to play a deleterious effect on patient survival. Advances on immunosuppressive drugs allowed the increase of kidney transplant on hypersensitized patients, with improvement of graft survival in those patients but also with a possible deleterious effect on patient survival. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-03-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692014000100006 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692014000100006 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692014000100006 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
dc.source.none.fl_str_mv |
Portuguese Journal of Nephrology & Hypertension v.28 n.1 2014 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799137279005949952 |