Patient and Graft Survival Outcomes During 2 Eras of Immunosuppression Protocols in Kidney Transplantation: Indiana University Retrospective Cohort Experience

To evaluate early surgical complications occurring in the first year after kidney transplantation, and their correlation with one-year patient and graft survival, we retrospectively evaluated 504 single kidney transplantations from heart-beating deceased donors performed in our center from 1993 to 2008. Twenty-seven re-transplanted patients, 10 living related, 8 double kidney, 9 combined liver-kidney, 3 heart-kidney, one heart-kidney-pancreas, and 12 kidney-pancreas transplantations were excluded from our study. Cases of immunological complications, systemic infections or primary disease recurrence were also excluded. There were 25 (4.96%) vascular complications: 3 cases of arterial thrombosis (0.6%), 11 of venous thrombosis (2.18%), and 2 cases of concomitant arterial and venous thrombosis (0.4%). There were 6 cases (1.2%) of arterial rupture due to pseudo-aneurysm; in 3 patients (0.6%) Candida Albicans was diagnosed as principal cause of arthritis. Fortythree (8.5%) patients developed early urinary complications, differentiated in leakage or stenosis. Intestinal complications occurred in 13 cases (2.6%), and 3 patients (0.6%) developed acute pancreatitis. In our series, complicated lymphoceles treated by open or laparoscopic surgery, or by the positioning of a Tenchkoff catheter occurred in 61 patients (12.10%). Median time between diagnosis and treatment was four days (range 1–12 days). Despite early surgical complications, one year patient and graft survival was 95.7% and 85.3%, respectively, similar to patients without complications (96.8% and 87.9%, respectively) (P=0.04). Kidney transplantation is currently considered a safe therapeutic option for endstage renal disease, with low morbidity, and very low mortality. Prompt diagnosis and immediate treatment of early surgical complications can have a positive impact on one-year patient and graft survival.

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MO943IMPACT OF NON-ACTIVE HEPATITIS B ON PATIENT SURVIVAL AFTER RENAL TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0022 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Anissa Paschereit ◽

Klemens Budde ◽

Michael Dürr ◽

Marcel Naik

Keyword(s):

Regression Analysis ◽

Kidney Transplantation ◽

Hepatitis B ◽

Graft Survival ◽

Graft Failure ◽

Patient Survival ◽

Kaplan Meier ◽

Primary Endpoints ◽

Increased Risk ◽

Patient And Graft Survival

Abstract Background and Aims Dialysis patients (pts) have an increased risk for hepatitis B (HB) infection and impaired response to HB vaccine compared to the general population. As shown in other studies, patient and graft survival in pts with chronic HB is worse. This study assesses the outcome of HBc-positive patients after kidney transplantation (KTx). Method In our retrospective analysis we included all patients >18 years old, who underwent kidney transplantation from 01.01.1990 to 31.08.2019 in our center. Patients were grouped by their serostatus prior to kidney transplantation into “A: naïve” (HB negative), “B: HBc-positive” (non-active HB) and “C: HBsAg-positive” (chronic HB). Primary endpoints included patient and graft survival analyzed with Kaplan-Meier and log-rank test. Regression analysis was applied to determine independent risk factors for the occurrence of primary endpoints. Results In 2487 kidney transplant patients, serologic markers were retrievable. We identified n=2198 HB naïve, n=218 non-active HB and n=75 chronic HB pts. Overall 29.1% (A:27.7%, B:37.6%, C:45.3%) pts died and 20.3% (A:19.1%, B:27.5%, C:37.3%) pts suffered from graft failure. The 5-year pts survival (Fig. 1) was A: 87.0%, B: 82.8%, C: 82.2%. The 10-year pts survival was A: 71.7%, B: 61.1%, C: 64.5% and the 20-year pts survival was A: 43.1%, B: 26.1%, C: 40.9% (p=0.01). Kaplan-Meier-analysis showed a 5-year graft survival (Fig. 2) of 87.7% in the naïve, 86.1% in non-active HB and 84.3% in chronic HB group. The 10-year graft survival was A: 77.3%, B: 64.9%, C: 76% and the 20-year graft survival was A: 59.7%, B: 52.2%, C: 33.4% (p<0.001). The overall 5-year pts and graft survival (Fig. 3) was A: 78.7%, B: 74.2%, C: 68.6%. The 10-year pts and graft survival was A: 59.8%, B: 46.4%, C: 51.8%. The 20-year overall rate was A: 30.8%, B: 26.4%, C: 14.9% (p<0.001). Regression analysis (Table 1) showed that anti-HBs positivity (≥100 IE/l) was a protective factor for graft failure and death (p<0.001). Conclusion HB leads to earlier graft loss and inferior patient survival. Beside the already known negative effect of chronic HB infection, also in patients with non-active HB infection overall survival was significant worse to HB naïve patients. Thus, non-active HB status is an important risk factor for overall transplant outcome. Next, influence of antiviral and immunosuppressive regimens and incidence of HB-reactivation are to be analyzed.

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