Patient And Allograft Survival After Transplantation With A Living Donor Kidney: 14 Years Experience.

BACKGROUND: Late allograft loss remains a key area of concern. This study was aimed at determining the patient and renal allograft outcome and identifying the factors responsible for survival following transplantation with a living-related donor kidney at the Nairobi Hospital, Kenya.
METHODS: Follow-up data for living-related donor graft recipients between 1988 and 2001 was collected. Outcome measures studied were patient and graft survival. Graft loss was defined by the need for permanent renal dialysis, repeat transplantation or death with a functioning graft. The Kaplan-Meier method was used to estimate survival. Crude mortality rates per 100 person-years of follow-up were also calculated. Outcome status was correlated with age, sex, readmission, creatinine level, duration of follow-up and financial sustainability. The Fischer's exact test, X² analysis and t-test were employed where appropriate. Logistic regression was used to detect independent risk factors for outcome. P<0.05 was considered significant.
RESULTS: Follow-up data were available for 45 of 53 patients. Six were subsequently lost to follow-up. The 1-year and 5-year patient survival was 77.8 and 63.1% respectively. The overall mortality was 10.7 per 100 person-years of follow-up. Risk of mortality was higher in the first year after transplantation (approximately double). Female gender, elevated serum creatinine levels, readmission and non-sustainable finances adversely affected patient outcome on univariate analysis. Overall graft survival was 77.8% at 1 year and 52.7% at 5 years. Most Deaths resulted from chronic allograft rejection and sepsis.
CONCLUSION: Pharmacological manipulations with newer immunosuppressive agents could reduce allograft loss and impact positively on patient survival.