Supervivència d'empelt i pacient a llarg termini en el trasplantament renal a Catalunya

Abstract

Renal transplantation is the treatment of choice for end stage chronic kidney disease. Works published in recent years show, in most cases, that patient and graft survival has clearly improved in the short term, while in the long term the results are not as conclusive. Assuming that during the last decades there has been a constant increase in the age and comorbidities of our recipients and that the use of expanded criteria donors has also increased, the main aim is to verify that the survival of kidney transplanted patients and renal grafts has improved both short and long-term, when donors and recipients are split into different groups of age. The secondary aims are: to study the different factors that may influence these survivals; to analyze data from patients with over-one-year functioning graft in order to evaluate long-term results without the influence of short-term survival improvement; and to study the causes of graft loss by periods of time and by groups of age. In order to reach these aims, all first single organ renal transplantations from deceased donor carried out in Catalonia on patients over 18 years old between 1992 and 2010 (n= 5,010) were considered, and the sample was divided into two periods: 1992-2001 and 2002-2010. The results show that, despite the fact that this is a more senior population, patients transplanted during the 2002-2010 period have a longer survival than those transplanted during the 1992-2001 period. The survival of the graft increases in the 2002-2010 period in all the groups of age when performing a univariate analysis; while when using a multivariate model, the period does not influence significantly since it is the new induction immunosuppressive therapy what influences the improvement of survival and not the period itself. Death censored graft survival increases during the 2002-2010 period in the univariate analysis, improving in all groups of age and, although in the older group it is not statistically significant, there is a trend to increase that is especially important in 10 years term survival. However, in the multivariate analysis the time period is not a significant factor in death censored graft survival. In patients whose functioning graft has lasted at least one year, the period in which the transplantation was performed influences the survival of the graft, both death censored or not. This association disappears in the death censored graft survival when adding the estimated glomerular filtration rate as a covariable, it may therefore be concluded that the improvement of renal function is what makes the results improve. Univariantly, it is observed that the older the age the more likely to lose the graft, but adjusting it for the different covariables, only patients over 65 years old are at greater risk. Regarding death censored graft survival, recipient’s age is unrelated with this survival. When analyzing the causes of graft loss, the main cause in the elderly recipients group is death with a functioning graft. In conclusion, we can state that graft and patient survival has increased in recent years despite the increase in age and comorbidities of our recipients.

Date of Award	13 Dec 2017
Original language	Catalan
Awarding Institution	Fundació Puigvert
Supervisor	Salvador Benito Vales (Tutor) & Luis Guirado Perich (Director)