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Recipient-Related Risk Factors for Graft Failure and Death in Elderly Kidney Transplant Recipients
BACKGROUND: Elderly patients with end-stage renal disease have become the fastest growing population of kidney transplant candidates in recent years. However, the risk factors associated with long-term outcomes in these patients remain unclear. METHODS: We retrospectively analyzed 166 recipients age...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229296/ https://www.ncbi.nlm.nih.gov/pubmed/25389964 http://dx.doi.org/10.1371/journal.pone.0112938 |
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author | Lai, Xingqiang Chen, Guodong Qiu, Jiang Wang, Changxi Chen, Lizhong |
author_facet | Lai, Xingqiang Chen, Guodong Qiu, Jiang Wang, Changxi Chen, Lizhong |
author_sort | Lai, Xingqiang |
collection | PubMed |
description | BACKGROUND: Elderly patients with end-stage renal disease have become the fastest growing population of kidney transplant candidates in recent years. However, the risk factors associated with long-term outcomes in these patients remain unclear. METHODS: We retrospectively analyzed 166 recipients aged 60 years or older who underwent primary deceased kidney transplantation between 2002 and 2013 in our center. The main outcomes included 1-, 3- and 5-year patient survival as well as overall and death-censored graft survival. The independent risk factors affecting graft and patient survival were analyzed using Cox regression analysis. RESULTS: The 1-, 3-, 5-year death-censored graft survival rates were 93.6%, 89.4% and 83.6%, respectively. Based on the Cox multivariate analysis, panel reactive antibody (PRA)>5% [hazard ratio (HR) 4.295, 95% confidence interval (CI) 1.321–13.97], delayed graft function (HR 4.744, 95% CI 1.611–13.973) and acute rejection (HR 4.971, 95% CI 1.516–16.301) were independent risk factors for graft failure. The 1-, 3-, 5-year patient survival rates were 84.8%, 82.1% and 77.1%, respectively. Longer dialysis time (HR 1.011 for 1-month increase, 95% CI 1.002–1.020), graft loss (HR 3.501, 95% CI 1.559–7.865) and low-dose ganciclovir prophylaxis (1.5 g/d for 3 months) (HR 3.173, 95% CI 1.063–9.473) were risk factors associated with patient death. CONCLUSIONS: The five-year results show an excellent graft and patient survival in elderly kidney transplant recipients aged ≥60 years. PRA>5%, delayed graft function, and acute rejection are risk factors for graft failure, while longer duration of dialysis, graft loss and low-dose ganciclovir prophylaxis are risk factors for mortality in elderly recipients. These factors represent potential targets for interventions aimed at improving graft and patient survival in elderly recipients. |
format | Online Article Text |
id | pubmed-4229296 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-42292962014-11-18 Recipient-Related Risk Factors for Graft Failure and Death in Elderly Kidney Transplant Recipients Lai, Xingqiang Chen, Guodong Qiu, Jiang Wang, Changxi Chen, Lizhong PLoS One Research Article BACKGROUND: Elderly patients with end-stage renal disease have become the fastest growing population of kidney transplant candidates in recent years. However, the risk factors associated with long-term outcomes in these patients remain unclear. METHODS: We retrospectively analyzed 166 recipients aged 60 years or older who underwent primary deceased kidney transplantation between 2002 and 2013 in our center. The main outcomes included 1-, 3- and 5-year patient survival as well as overall and death-censored graft survival. The independent risk factors affecting graft and patient survival were analyzed using Cox regression analysis. RESULTS: The 1-, 3-, 5-year death-censored graft survival rates were 93.6%, 89.4% and 83.6%, respectively. Based on the Cox multivariate analysis, panel reactive antibody (PRA)>5% [hazard ratio (HR) 4.295, 95% confidence interval (CI) 1.321–13.97], delayed graft function (HR 4.744, 95% CI 1.611–13.973) and acute rejection (HR 4.971, 95% CI 1.516–16.301) were independent risk factors for graft failure. The 1-, 3-, 5-year patient survival rates were 84.8%, 82.1% and 77.1%, respectively. Longer dialysis time (HR 1.011 for 1-month increase, 95% CI 1.002–1.020), graft loss (HR 3.501, 95% CI 1.559–7.865) and low-dose ganciclovir prophylaxis (1.5 g/d for 3 months) (HR 3.173, 95% CI 1.063–9.473) were risk factors associated with patient death. CONCLUSIONS: The five-year results show an excellent graft and patient survival in elderly kidney transplant recipients aged ≥60 years. PRA>5%, delayed graft function, and acute rejection are risk factors for graft failure, while longer duration of dialysis, graft loss and low-dose ganciclovir prophylaxis are risk factors for mortality in elderly recipients. These factors represent potential targets for interventions aimed at improving graft and patient survival in elderly recipients. Public Library of Science 2014-11-12 /pmc/articles/PMC4229296/ /pubmed/25389964 http://dx.doi.org/10.1371/journal.pone.0112938 Text en © 2014 Lai et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Lai, Xingqiang Chen, Guodong Qiu, Jiang Wang, Changxi Chen, Lizhong Recipient-Related Risk Factors for Graft Failure and Death in Elderly Kidney Transplant Recipients |
title | Recipient-Related Risk Factors for Graft Failure and Death in Elderly Kidney Transplant Recipients |
title_full | Recipient-Related Risk Factors for Graft Failure and Death in Elderly Kidney Transplant Recipients |
title_fullStr | Recipient-Related Risk Factors for Graft Failure and Death in Elderly Kidney Transplant Recipients |
title_full_unstemmed | Recipient-Related Risk Factors for Graft Failure and Death in Elderly Kidney Transplant Recipients |
title_short | Recipient-Related Risk Factors for Graft Failure and Death in Elderly Kidney Transplant Recipients |
title_sort | recipient-related risk factors for graft failure and death in elderly kidney transplant recipients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229296/ https://www.ncbi.nlm.nih.gov/pubmed/25389964 http://dx.doi.org/10.1371/journal.pone.0112938 |
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