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Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective

INTRODUCTION: Access to dialysis and transplantation in the developing world remains limited. Therefore, optimising renal allograft survival is essential. This study aimed to evaluate clinical outcomes and identify poor prognostic factors in the renal transplant programme at Groote Schuur Hospital [...

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Autores principales: Davidson, Bianca, Du Toit, Tinus, Jones, Erika S. W., Barday, Zunaid, Manning, Kathryn, Mc Curdie, Fiona, Thomson, Dave, Rayner, Brian L., Muller, Elmi, Wearne, Nicola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347365/
https://www.ncbi.nlm.nih.gov/pubmed/30682138
http://dx.doi.org/10.1371/journal.pone.0211189
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author Davidson, Bianca
Du Toit, Tinus
Jones, Erika S. W.
Barday, Zunaid
Manning, Kathryn
Mc Curdie, Fiona
Thomson, Dave
Rayner, Brian L.
Muller, Elmi
Wearne, Nicola
author_facet Davidson, Bianca
Du Toit, Tinus
Jones, Erika S. W.
Barday, Zunaid
Manning, Kathryn
Mc Curdie, Fiona
Thomson, Dave
Rayner, Brian L.
Muller, Elmi
Wearne, Nicola
author_sort Davidson, Bianca
collection PubMed
description INTRODUCTION: Access to dialysis and transplantation in the developing world remains limited. Therefore, optimising renal allograft survival is essential. This study aimed to evaluate clinical outcomes and identify poor prognostic factors in the renal transplant programme at Groote Schuur Hospital [GSH], Cape Town.      METHOD: Data were collected on all patients who underwent a kidney transplant at GSH from 1st July 2010 to the 30 June 2015. Analyses were performed to assess baseline characteristics, graft and patient survival, as well as predictors of poor outcome.     RESULTS: 198 patients were transplanted. The mean age was 38 +/- 10.5 years, 127 (64.1%) were male, and 86 (43.4%) were of African ethnicity. Deceased donor organs were used for 130 (66.7%) patients and living donors for 65 (33.3%). There were > 5 HLA mismatches in 58.9% of transplants. Sepsis was the commonest cause of death and delayed graft function [DGF] occurred in 41 (21.4%) recipients. Patient survival was 90.4% at 1 year and 83.1% at 5 years. Graft survival was 89.4% at 1 year and 80.0% at 5 years. DGF (HR 2.83 (1.12–7.19), p value = 0.028) and recipient age > 40 years (HR 3.12 (1.26–7.77), p value = 0.014) were predictors of death. CONCLUSION: Despite the high infectious burden, stratified immunosuppression and limited tissue typing this study reports encouraging results from a resource constrained transplant programme in South Africa. Renal transplantation is critical to improve access to treatment of end stage kidney disease where access to dialysis is limited.
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spelling pubmed-63473652019-02-15 Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective Davidson, Bianca Du Toit, Tinus Jones, Erika S. W. Barday, Zunaid Manning, Kathryn Mc Curdie, Fiona Thomson, Dave Rayner, Brian L. Muller, Elmi Wearne, Nicola PLoS One Research Article INTRODUCTION: Access to dialysis and transplantation in the developing world remains limited. Therefore, optimising renal allograft survival is essential. This study aimed to evaluate clinical outcomes and identify poor prognostic factors in the renal transplant programme at Groote Schuur Hospital [GSH], Cape Town.      METHOD: Data were collected on all patients who underwent a kidney transplant at GSH from 1st July 2010 to the 30 June 2015. Analyses were performed to assess baseline characteristics, graft and patient survival, as well as predictors of poor outcome.     RESULTS: 198 patients were transplanted. The mean age was 38 +/- 10.5 years, 127 (64.1%) were male, and 86 (43.4%) were of African ethnicity. Deceased donor organs were used for 130 (66.7%) patients and living donors for 65 (33.3%). There were > 5 HLA mismatches in 58.9% of transplants. Sepsis was the commonest cause of death and delayed graft function [DGF] occurred in 41 (21.4%) recipients. Patient survival was 90.4% at 1 year and 83.1% at 5 years. Graft survival was 89.4% at 1 year and 80.0% at 5 years. DGF (HR 2.83 (1.12–7.19), p value = 0.028) and recipient age > 40 years (HR 3.12 (1.26–7.77), p value = 0.014) were predictors of death. CONCLUSION: Despite the high infectious burden, stratified immunosuppression and limited tissue typing this study reports encouraging results from a resource constrained transplant programme in South Africa. Renal transplantation is critical to improve access to treatment of end stage kidney disease where access to dialysis is limited. Public Library of Science 2019-01-25 /pmc/articles/PMC6347365/ /pubmed/30682138 http://dx.doi.org/10.1371/journal.pone.0211189 Text en © 2019 Davidson 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 (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Davidson, Bianca
Du Toit, Tinus
Jones, Erika S. W.
Barday, Zunaid
Manning, Kathryn
Mc Curdie, Fiona
Thomson, Dave
Rayner, Brian L.
Muller, Elmi
Wearne, Nicola
Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective
title Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective
title_full Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective
title_fullStr Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective
title_full_unstemmed Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective
title_short Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective
title_sort outcomes and challenges of a kidney transplant programme at groote schuur hospital, cape town: a south african perspective
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347365/
https://www.ncbi.nlm.nih.gov/pubmed/30682138
http://dx.doi.org/10.1371/journal.pone.0211189
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