Over ten-year kidney graft survival determinants

Abstract

Kidney graft survival has been mainly evaluated using an up to 10-year threshold. Instead, in this study our aim was to evaluate predictive variables that impact long-term kidney graft survival (≥10 years). We enrolled 892 patients in our analysis: 638 patients with functioning graft at 10 years PT and 254 patients with graft failure at 10 years PT (considering patient death with a functioning graft <10 years PT as graft failure). Between groups comparisons were done using Mann-Whitney and chi-square test. To determine independent predictive variables for long-term graft survival a multivariate-adjusted logistic regression was performed. Significant predictors of long term graft survival were lower 12-month PT creatinine (OR=0.26, P<0.001), lower donor age (OR=0.98, P=0.004), shorter time on dialysis (OR=0.93, P=0.044), recipient positive CMV IgG (OR=1.59, P=0.040), absence of AR episodes (OR=1.57, P=0.047), 0 to 1 (versus 2) HLA-B mismatch (OR=1.80, P=0.004), and recipients male gender (OR=1.84, P=0.005). Our results show that an early KT, younger donor age, and an optimal first year graft function are of paramount importance for long-term graft survival. Measures that address these issues (careful donor selection, preemptive KT, and effective immunosuppressive protocols) are still warranted. © 2012 Anabela Malho Guedes et al.