The kidney transplant experience at Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Guadalajara México.

A total of 1,356 kidney transplants has been performed in the Hospital de Especialidades del Centro Médico Nacional de Occidente, IMSS, in Guadalajara Mexico, including 935 in the past 8 years. This represents an important increase of this activity in our country. Of the total transplants, 1,218 (90%) were from living donors and only 138 (10%) were from cadaveric donors, a number that we hope to increase. Most recipients were young adults, with an average age of 31 years old. The overall one-year graft and patient survival rates for living-donor kidney recipients were 90% and 82%, and for cadaveric kidney recipients they were 80% and 70%, respectively. Acute rejections occurred in 17% and chronic allograft nephropathy was diagnosed in 7% of our kidney transplant recipients. The main cause of patient death was infection, frequently invasive CMV. Cardiovascular complications were a relatively infrequent cause of death as has been seen in other international series. Hepatitis B and C have been widley studied. Hepatitis C is the most prevalent viral infection in our population. Both living and cadaveric donors in our series were young, which may explain the good results. We have had very few complications among living donors and no mortality. Two donors developed chronic renal insufficiency after the kidney donation (0.001%). This excellent safety record reflects the experience of our team. We hope to increase the number of cadaveric transplant donors with the renewed interest in enlarging the transplantation programs in Mexico while maintaining our high percentage of living donors in order to benefit more patients.

Risk factors for long-term graft loss in kidney transplantation: experience of a Mexican single-center.

BACKGROUND/AIM: There is not enough information regarding risk factors for renal graft loss in Mexico and Latin America. The aim of this study was to analyze risk factors associated with graft loss in our renal transplant (RT) population. METHODS: Clinical records of 326 patients with a first RT performed between August/76 and June/99 were reviewed. Clinical and laboratory variables were recorded, as well as the final patient and renal function status. STATISTICAL ANALYSIS: Survival analysis by Kaplan-Meier method; mortality risk by multivariate Cox's proportional hazard model. RESULTS: At the end of the study, 275 patients were alive, 30 were dead, 21 lost to follow-up; 65 patients (20%) had reinitiated dialysis. Patient survival at 1, 3, 5, 8, and 10 years was 92%, 86%, 81%, 77%, and 77%, respectively. Graft survival at 1, 3, 5, 8, and 10 years was 87%, 73%, 64%, 50%, and 47%, respectively. In the univariate analysis, the following were significantly associated (p < 0.05) with graft loss: acute rejection episodes, cadaveric donors, and HLA haplotype mismatches. In the multivariate analysis, only acute rejection (RR 2.12, p = 0.002) and a lower HLA haplotype matching (RR 0.37, p = 0.002) predicted graft loss. CONCLUSIONS: In Mexican population, graft survival was similar to the reported in developed countries. The main risk factors for long-term graft failure were acute rejection and HLA haplotype mismatching.