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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ASIA - AFRICA Table of Contents   
Year : 2007  |  Volume : 18  |  Issue : 3  |  Page : 439-442
The Comparison of Clinical and Biochemical Parameters among 1200 alive and dead Renal Transplant Recipients


Shiraz Organ Transplantation Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

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   Abstract 

With increasing long-term graft survival and life-long immunosuppression, cardiovascular disease and infectious complications are major causes of morbidity and mortality. We retrospectively evaluated 1200 consecutive kidney transplant patients at Shiraz Organ Transplant Center from December 1988 to December 2003. Data on demographic profile, donor source, blood pressure, rejection episodes, cause of death, and hematological and biochemical serum profiles were collected to compare alive and dead recipients. One hundred fifty six patients (13%) died in the post transplant period. Patient death was more prominent during the first years after transplantation. Most common causes of death were cardiovascular (28.3%), graft loss (20.7%), and infection (19.6%). Post transplant systolic and diastolic blood pressures, BUN, creatinine, fasting blood sugar, and total cholesterol were higher, and serum HDL lower in the dead recipients than those who remained alive (P<0.05). No significant difference was found in LDL, hemoglobin, and triglyceride values between the two groups. The one- and three-year patient survival rates were 94% and 91.5%, respectively. We conclude that the patients who died after transplantation had more risk factors than stable patients who remain alive. A multidisciplinary approach to control the co-morbid factors could be beneficial to decrease the mortality of patients after renal transplantation.

Keywords: Renal, Transplantation, Survival, Mortality, Cardiovascular, Complications.

How to cite this article:
Salahi H, Jalaeian H, Nikeghbalian S, Davari HR, Bahador A, Roozbeh J, Sagheb MM, Rais-Jalali GA, Behdazi S, Malek-Hosseini SA. The Comparison of Clinical and Biochemical Parameters among 1200 alive and dead Renal Transplant Recipients. Saudi J Kidney Dis Transpl 2007;18:439-42

How to cite this URL:
Salahi H, Jalaeian H, Nikeghbalian S, Davari HR, Bahador A, Roozbeh J, Sagheb MM, Rais-Jalali GA, Behdazi S, Malek-Hosseini SA. The Comparison of Clinical and Biochemical Parameters among 1200 alive and dead Renal Transplant Recipients. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2020 Jun 5];18:439-42. Available from: http://www.sjkdt.org/text.asp?2007/18/3/439/33767

   Introduction Top


Renal transplantation is well recognized as the preferable therapy for improving quality of life in patients with end-stage renal disease (ESRD). [1] However, with increasing long- term graft survival and life-long immuno­suppression, cardiovascular disease and infe­ctious complications emerge as major causes of morbidity and mortality.[2]

In this retrospective study, we report a single center long-term follow-up of renal transplant patients and compare clinical and biochemical risk factors, graft complications, and rejection episodes of living and dead kidney recipients.


   Material and Methods Top


We retrospectively evaluated 1200 con­secutive kidney transplant patients at Namazee Hospital in Shiraz (Southern Iran) Organ Transplant Center from December 1988 to December 2003. One hundred fifty six (13%) patients died in the post transplant period. In addition to the Persian Network for Organ Transplant (PNOT), patient files were used as data sources. Data of demographic profile, donor source, blood pressure, rejection episodes, cause of death, and hematological and bio­-chemical serum profiles were collected to compare alive and dead recipients. The immunosuppressive protocol used in our transplant unit consisted of cyclosporine (CsA), methyl-prednisolone, azathioprine, mycophenolate mofetil, and prednisolone. Regular indefinite follow-up was considered uniformly for all patients.


   Statistical analysis Top


Discrete variables were compared using the X 2 test. For continuous variables, Student's test was used. P< 0.05 was considered as significant. Patient survival rates were computed with the Kaplan-Meier analysis.


   Results Top


One hundred fifty six (13%) patients died in the post transplant period. Patient death was more prominent in the first few years of the study. Most common causes of death were cardio-vascular (28.3%), graft loss (20.7%), and infection (19.6%). [Table - 1] shows hemato­logical, and biochemical data of alive and dead recipients. On average, dead recipients were older, and had higher male/female ratios. Post transplant systolic and diastolic blood pressures were higher in dead recipients. Furthermore, post transplant biochemical variables such as BUN, creatinine, fasting blood sugar, and total cholesterol were higher, and serum HDL was lower in dead recipients than in living patients (P<0.05). However, we did not find any significant differences in LDL, hemoglobin, and triglyceride values. Death occurred more in male recipients with male donors than female recipients with female donors, however, it did not reach statistical significance. The one- and three-year patient survival rates were 94% and 91.5%, and graft survival rates were 88% and 84%, respectively.


   Discussion Top


The current data reflect survival rates comparable to major centers throughout the world. [3],[4],[5] Despite the improvement in short and long-term kidney allograft survival in recent years, a significant number of grafts are lost because of chronic allograft nephropathy (CAN) or death secondary to cardiovascular disease (CVD). There is growing evidence that hypertension, hyperlipidemia, and post-trans­plantation diabetes mellitus play important roles in the progression of CAN and CVD in kidney transplant recipients. [6],[7] It is obvious that the immunosuppressive agents used today have negative influences on risk factors for CVD. [7],[8]

In our study, mean post-transplant systolic and diastolic blood pressure, fasting blood sugar, and total cholesterol were higher, and serum HDL was lower in dead recipients than those who remained alive (P<0.05). How­ever, it is not clear why we did not find any differences in serum triglyceride and LDL. Hyperlipidemia is common after trans­plantation and immunosuppression with corticosteroids, and cyclosporine, etc causes different types of post-transplantation hyperlipidemia. [7] We used the same immunosuppressive proto-col for all kidney transplant patients. This may be the reason why we found the same serum triglyceride and LDL values in both groups. Further studies with longer follow-up of this cohort, which include a greater number of people and increased length of graft function, are required.

Overall, it seems reasonable to adopt the principle of a multidisciplinary approach aimed at reducing LDL, cholesterol, mean blood pressure, and other major risk factors for cardio­vascular disease with individual tailoring of immunosuppressive therapies to reduce CAN and CVD in this patient population. On the other hand, high prevalence of infection can be reduced with early diagnosis, use of proper antibiotics, better post operative care, and avoidance of excessive and unnecessary immunosuppression. [9]

 
   References Top

1.Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725-30.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Candan S, Pirat A, Varol G, Torgay A, Zeyneloglu P, Arslan G. Respiratory problems in renal transplant recipients admitted to intensive care during long-term follow-up. Transplant Proc 2006;38:1354-6.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Haberal M, Gulay H, Tokyay R, et al. Living unrelated donor kidney transplanta­tion between spouses. World J Surg 1992;16:1183-7.  Back to cited text no. 3  [PUBMED]  
4.Rashed A, Aboud O. Renal trans­plantation: seventeen years of follow-up in Qatar. Transplant Proc 2004;36:1835-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Poblete H, Toro J, Nicovani V, et al. Survival of grafts in the first 100 renal transplants at the Carols van Buren Hospital. Rev Med Chil 2001;129:763-6.  Back to cited text no. 5  [PUBMED]  
6.El-Amm JM, Haririan A, Crook ED. The effects of blood pressure and lipid control on kidney allograft outcome. Am J Cardiovasc Drugs 2006;6:1-7.  Back to cited text no. 6  [PUBMED]  
7.Fellstorm B. Risk factors for and management of post-transplantation cardiovascular disease. BioDrugs 2001;15:261-78.  Back to cited text no. 7    
8.Wanner C, Barten W, Galle J. Clinical utility of antilipidemic therapies in chronic renal allograft failure. Kidney Int Suppl 1995;52:S60-2.  Back to cited text no. 8    
9.Rubin RH. Infectious disease complications of renal transplantation. Kidney Int 1993; 44:221-36.  Back to cited text no. 9  [PUBMED]  

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Correspondence Address:
Heshmatollah Salahi
Namazee Hospital, Shiraz University of Medical Sciences, Shiraz
Iran
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PMID: 17679761

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    Abstract
    Introduction
    Material and Methods
    Statistical analysis
    Results
    Discussion
    References
    Article Tables
 

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