Sobrevida del paciente y del injerto renal: Receptores de Trasplante Renal en el Hospital de San José de 1996 a 2004

Survival of the patient and renal graft: Renal Transplant Receptors at the San José Hospital from 1996 to 2004

Es un estudio observacional descriptivo retrospectivo de los pacientes con falla renal terminal sometidos a trasplante renal en el Hospital de San José entre 1996 y 2004. Se analizaron las características clínicas y quirúrgicas y su relación con la sobrevida de los receptores y del injerto a cinco años, usando los métodos univariado, bivariado, de frecuencia y una curva de probabilidad de sobrevida. 110 pacientes recibieron un trasplante renal en el hospital durante este lapso y se obtuvo información de 102 de ellos. El promedio de edad fue 35.53 años con desviación estándar (DE) de 13.25 años, la distribución por género fue 53,9% de hombres y 46.1% mujeres. El tipo de donante fue vivo 13,7% y cadavérico 86,3%. Hubo una tasa de sobrevida de los receptores a cinco años del 86,28% (88 pacientes) y el 92,85% de las muertes ocurrieron en los dos primeros meses. La tasa de sobrevida del injerto a cinco años fue del 70% según los datos analizados en 85 pacientes. Consideramos que el retardo de la función del injerto, el rechazo agudo y la influencia del cambio en los esquemas inmunosupresores debe analizarse puntualmente. Además, se puede desarrollar un sistema de pareamiento de los injertos según la masa metabólica del paciente, la edad y la función previa entre donadores y receptores, para evaluar su influencia en la función del injerto. Abreviaturas: DE, desviación estándar; TVP, trombosis venosa profunda.

1. Nacional Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 feb; 39 (2 Suppl 1): S1-266

2. Danovitch GM. Trasplante renal. 3'. ed. Barcelona: Marban; 2002.

3. Venkateswara Rao. Trasplante renal. Surg Clin North Am. 1998 Feb; 78 (1): 1-167

4. Cecka JM. The UNOS Renal Transplant Registry. Clin Transpl. 2002; 1-20.

5. Schweiger M, Wasler A, Prenner G, Tripolt M, Zink M, Duller D, Schwarz M, Tscheliessnigg KH. Improving the rate of organ donation. Transplant Proc. 2004 Nov; 36 (9): 2543-5.

6. Nishikido M, Noguchi M, Koga S, Kanetake H, Matsuyama F, Hayashi M, Hori T, Shindo K. Kidney transplantation from non.heart-beating donors: analysis of organ procurement and outcome. Transplant Proc. 2004 Sep; 36 (7): 1888-90.

7. Johnston TD, Thacker LR, Jeon H, Lucas BA, Ranjan D. Sensitivity of expanded-criteria donor kidneys to cold ischaemia time. Clin Transplant. 2004; 18 Suppl 12:28-32.

8. Siddiqi N, McBride MA, Hariharan S. Similar risk profiles for post-transplant renal dysfunction and long-term grafi failure: UNOS/OPTN database analysis. Kidney Int. 2004 May; 65 (5): 1906-13.

9. Schnuelle P, Yard BA, Braun C, Dominguez-Fernandez E, Schaub M, Birck R, Sturm J, Post S, van der Woude FJ. Impact of donor dopamine on immediate graft function after kidney transplantation. Am J Transplant. 2004 Mar; 4 (3): 419-26.

10. Giessing M, Budde K, Fritsche L, Slowinsky T, Tuerk I, Schoenberger B, Neumayer HH, Loening SA. "Old-forold" cadaveric renal transplantation: surgical findings, perioperative complications and outcome. Eur Urol. 2003 Dec; 44 (6): 701-8.

11. Herrero JC, Gutierrez E, Martinez A, Gonzalez E, Morales E, Muñoz MA, Valentin M, Bueno B, Praga M, Hernandez E, Morales JM, Rodicio JL, Andres A. Results of kidney transplantation in recipients over 70 years of age: experience at a single center. Transplant Proc. 2003 Aug; 35 (5): 1675-6.

12. Koffman G, Gambaro G. Renal transplantation from nonheart- beating donors: a review of the European experience. J Nephrol. 2003 May-Jun; 16 (3): 334-41.

13. Gomez Vegas A, Blazquez Izquierdo J, Bocardo Fajardo G, San Jose Manso L, Fernandez Perez C, Silmi Moyano A, Resel Estevez L. Renal transplantation in donors over 60 years of age. Arch Esp Urol. 2003 Mar; 56 (2): 151-9

14. Kunzendorf U, Hohenstein B, Oberbarnscheid M, Muller E, Renders L, Schott GE, Offermann G. Duration of donor brain death and its influence on kidney graft function. Am J Transplant. 2002 Mar; 2 (3): 292-4

15. Mor E, Michowiz R, Ashkenazi T, Shabtai E, Nakache R, Eid A, Hoffn an A, Mizrahi S, Shabtai M, Shapira Z. Extension of the organ pool in kidney transplantation: first year experience of the Israel Transplant Center, Isr Med Assoc J. 2000 Apr; 2 (4): 302-5

16. Light JA, Barhyte DY, Gage FA, Sasaki TM, Aquino AO. Long-term graft survival after transplantation with kidneys from uncontrolled nonheartbeating donors. Transplantation. 1999 Dec 27; 68 (12): 1910-1

17. Akioka K, Takahara S, Ichikawa S, Yoshimura N, Akiyama T, Ohshima S. Factors predicting long-term graft survival after kidney transplantation: multicenter study in Japan. World J Surg. 2005 Feb; 29 (2): 249-56.

18. Santos ES, Raez LE, Kharfan-Dabaj a MA, Angulo J, Restrepo A, Byrnes JJ., Survival of renal allograft following de novo hemolytic uremic syndrome after kidney transplantation. Transplant Proc. 2003 Jun; 35 (4): 1370-4.

19. Koning OH, Ploeg RJ, van Bockel JH, Groenewegen M, van der Woude FJ, Persijn GG, Hermans J. Risk factors for delayed graft function in cadaveric kidney transplantation: a prospective study of renal function and graft survival after preservation with University of Wisconsin solution in multiorgan donors. European Multicenter Study Group. Transplantation. 1997 Jun 15; 63 (11): 1620-8.

20. Asher J, Wilson C, Gok M, Balupuri S, Bhatti AA, Soomro N, Rix D, Jaques B, Manas D, Shenton B, Talbot D. Factors predicting duration of delayed graft function in non-heartbeating donor kidney transplantation. Transplant Proc. 2005 Jan-Feb; 37 (1): 348-9.

21. Lebranchu Y, Halimi JM, Bock A, Chapman J, Dussol B, Fritsche L, Kliem V, Oppenheimer F, Pohanka E, Salvadori M, Soergel M, Tufveson G; MOST International Study Group. Delayed graft function: risk factors, consequences and parameters affecting outcome-result from MOST, A Multinational Observational Study. Transplant Proc. 2005 Jan-Feb; 37 (1): 345-7.

22. Peeters P, Terryn W, Vanholder R, Lameire N. Delayed graft function in renal transplantation. Curr Opin Crit Care. 2004 Dec; 10 (6): 489-98. 23. Park YH, Min SK, Lee JN, Lee HH, Jung WK, Lee JS, Lee YD. Risk factors on graft survival of living donor kidney transplantation. Transplant Proc. 2004 Sep: 36 (7): 2023- 5.

24. Groenewoud AF, Thorogood J.A Preliminary report of the HTK randomized multicenter study comparing kidney graft preservation with HTK and EuroCollins solutions. HTK Study Group. Transpl Int. 1992; 5 Suppl 1:S429-32.

25. Renal transplantation in Helsinki: influence on long-term survival of early posttranplant factors. Clin Transpl. 1999: 173-9.

26. Goldfarb DA. Ureteral necrosis after kidney transplantation: risk factors and impact on graft and patient survival. J Urol. 2005 Mar; 173 (3): 888-9.

27. Karam G, Maillet F, Parant S, Soulillou JP, Giral-Classe M Ureteral necrosis after kidney transplantation; risk factors and impact on graft and patient survival. Transplantation. 2004 Sep 15; 78 (5): 725-9.

28. Jimenez del Cerro LA, Franco A, Rivera F, Olivares J. Changes in renal function in renal transplantation. Predictive factors for functional deterioration Nefrologia. 2001 May-Jun; 21 (3): 295-304.

29. Dlugosz R. Evaluation of factors affecting early and late outcome of 225 kidney transplantations Ann Acad Med Stetin. 1999; 45: 93-107

30. Tejani AH, Sullivan EK, Alexander SR, Fine RN; Harmon WE, Kohaut EC. Predictive factors for delayed graft function (DGF) and its impact on renal graft survival in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant. 1999 Nov; 3 (4): 293-300.

31. Faenza A, Nardo B, Catena F, Scolari MP, d'Arcanuelo GL, Buscaroli A, Rossi C, Zompatori M. Ureteral stenosis alter kidney transplantation. A study on 869 consecutive transplants. Transpl. Int. 1999; 12 (5): 334-40

32. Matteucci E, Carmellini M, Bertoni C, Boldrini E, Mosca F, Giampietro O. Urinary excretion rates of multiple renal indicators alter kidney transplantation: clinical significance for early graft outcome. Ren Fail. 1998 Mar; 20 (2): 325- 30.

33. Cecka JM. The UNOS renal transplant registry. Clin Transpl. 2001; 1-18.

34. Cecka JM. The UNOS Scientific Renal Transplant Registry2000. Clin Transpl. 2000; 1-20.

35. Cecka JM. The UNOS Scientific Renal Transplant Registry. Clin Transpl. 1998; 1-16.

36. Gok MA, Buckley PE, Shenton BK, Balupuri S, El-Sheikh MA, Robertson H, Soomro N, Jaques BC, Manas DM, Talbot D. Long-term renal function in kidneys from nonheart-beating donors: A single-center experience. Transplantation. 2002 Sep 15; 74 (5): 664-9.

37. Park YH, Min SK, Lee JN, Lee HH, Jung WK, Lee JS, Lee JH, Lee YD. Comparison of survival probabilities for living-unrelated versus cadaveric renal transplant recipients. Transplant Pro. 2004 Sep; 36 (7): 2020-2.

38. Berardinelli L, Beretta C, Raiteri M, Carini M. Early and long-term results using older kidneys from cadaver or living donors. Clin Transpl. 2001; 157-66.

39. Cosio FG, Pelletier RP, Pesavento TE, Henry ML, Ferguson RM, Mitchell L, Lemeshow S. Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients. Kidney Int. 2001 Mar: 59 (3): 1158-64.

40. Kyllonen LE, Salmela KT, Eklund BH, Halme LE, Hockerstedt KA, Isoniemi HM, Makisalo HJ, Ahonen J. Longterm results of 1047 cadaveric kidney transplantations with special emphasis on initial graft function and rejection. Transpl Int. 2000; 13 (2): 122-8

41. Humar A, Johnson EM, Payne WD, Wrenshall L, Sutherland DE, Najarian JS, Gillingham KJ, Matas AJ, Effect of initial slow graft function on renal allograft rejection and survival. Clin Transplant. 1997 Dec; 11 (6): 623-7.

42. Shoskes DA, Avelino L, Barba L, Sender M. Patient death or renal graf loss within 3 yr of transplantation in a county hospital: importance of poor initial graft function. Clin Transplant. 1997 Dec; 11 (6): 618-22.

43. Lehtonen SR, Isoniemi HM, Salmela KT, Taskinen El, von Willebrand EO, Ahonen JP. Long-term graft outcome is not necessarily affected by delayed onset of graft function and early acute rejection. Transplantation. 1997 Jul 15; 64 (1): 103-7.

44. Gjertson DW. Impact of delayed graft function and acute rejection on kidney graft survival. Clin Transpl. 2000; 467- 80.

45. Paul LC Chronic allograft nephropathy: An update. Kidney Int. 1999 Sep; 56 (3): 783-93.

46. Grinyo JM, Gil-Vernet S, Cruzado JM, Caldes A, Riera L, Seron D, Rama I, Torres J. Calcineurin inhibitor-free immunosuppression based on antithymocyte globulin and mycophenolate mofetil in cadaveric kidney transplantation: results after 5 years. Transpl Int. 2003 Nov; 16 (11): 820- 7.

47. Matas AJ, Ramcharan T, Paraskevas S, Gillingham KJ, Dunn DL, Gruessner RW, Humar A Kandaswamy R, Najarian JS, Payne WD, Sutherland DE. Rapid discontinuation of steroids in living donor kidney transplantation: a pilot study. Am J Transplant. 2001 Sep; 1 (3): 278-83.

48. Jha V, Muthukumar T, Kohli HS, Sud K, Gupta KL, Sakhuja V. Impact of cyclosporine withdrawal on living related renal transplants: a single-center experience. Am J Kidney Dis. 2001 Jan; 37 (1): 119-124.