RESUMO
Although donor and recipient risk factors for renal allograft failure are well known after kidney transplantation, they are less well defined after simultaneous pancreas-kidney transplantation. The purpose of this study is to evaluate the impact of donor and recipient risk factors on the outcome of the renal allograft in simultaneous pancreas-kidney recipients. Simultaneous pancreas-kidney transplant performed between 4/88 and 6/94 were reviewed (n = 61) and univariate (Kaplan-Meier) and multivariate (Cox regression) analyses of factors which affect kidney graft survival were performed. Twelve donor and eleven pre- and post-transplant recipient risk factors were evaluated. Overall kidney allograft survival rates at 1, 2 and 5 yr were 81%, 76% and 66%. Donor age > and = 40 yr (RR = 2.3), donor female gender (RR = 3.5), donor admission to pronouncement of brain death > and = 48 h (RR = 3), the occurrence of surgical complications (RR = 2.1), and serum > and = 2 mg/dl on post-transplant day (RR = 1.9) were independently associated with an increased hazard of graft failure. With the exception of length of donor admission, all of these factors were also shown to predict the risk of renal graft failure by univariate analysis. In conclusion, we have identified donor and recipient risk factors which independently predict the risk of renal graft failure after simultaneous pancreas-kidney transplantation. Whether the differences between our center-specific risk factors and those obtained from renal transplant registry data are true differences or simply reflect sampling error is unclear.
Assuntos
Sobrevivência de Enxerto , Transplante de Rim/métodos , Rim/fisiologia , Transplante de Pâncreas/métodos , Doadores de Tecidos , Adolescente , Adulto , Fatores Etários , Análise de Variância , Criança , Feminino , Humanos , Masculino , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Transplante Homólogo , Resultado do TratamentoAssuntos
Rejeição de Enxerto/etiologia , Transplante de Rim/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Adolescente , Adulto , Fatores Etários , Criança , Creatinina/sangue , Humanos , Transplante de Rim/fisiologia , Pessoa de Meia-Idade , Análise Multivariada , Transplante de Pâncreas/fisiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Doadores de TecidosRESUMO
BACKGROUND: Donor and recipient selection criteria for pancreas allograft are not standardized and may vary from center to center. METHODS: Simultaneous pancreas-kidney transplantations performed between April 1988 and June 1994 were reviewed (n = 61), and univariate and multivariate analyses of factors that affect pancreas graft survival were performed. Analysis of all cases and cases excluding early thrombosis were performed separately. RESULTS: Pancreas graft survival when early thrombosis was excluded and in the overall group was 76% and 70%, respectively, at 1 year. Although blood group and donor gender were weak predictors of graft survival by univariate analysis, neither affected graft survival in the multivariate model. Risk factors for graft failure as determined by Cox regression analysis and in descending order of significance were (1) duration of brain death before procurement, (2) length of donor admission, and (3) donor age of 40 years or older. The risk of graft failure for each of these factors was increased 2.2-, 3.2-, and 4-fold, respectively. Prolonged brain death was the only risk factor in the overall group, suggesting an association with early thrombosis. CONCLUSIONS: Center-specific donor risk factors for pancreas graft survival after simultaneous pancreas-kidney transplantation were identified in this study, the importance of which need to be better defined.
