Nefrología Vol. 34 Nº 5 Año 2014
Nefrologia (Madr.) 2014;34:570-8 | doi: 10.3265/Nefrologia.pre2014.Jun.12327

Impacto de la inmunosupresión en la mejora de la supervivencia del injerto tras un transplante renal de donante cadáver: estudio de cohorte a largo plazo

Impact of immunosuppression treatment on the improvement in graft survival after deceased donor renal transplantation: a long-term cohort study


a Servicio de Nefrolog??a, Hospital Regional Universitario Carlos Haya/IBIMA, M??laga,
b Servicio de Nefrolog??a, Hospital Torrec??rdenas, Almer??a,
c Servicio de Urolog??a, Hospital Regional Universitario Carlos Haya, M??laga,
Resumen

Análisis de la vida media del injerto y de su tasa de pérdida en 1045 transplantes de donantes cadáver adultos entre 1986 y 2001, con seguimiento hasta 2011, clasificados en dos periodos en función de la inmunosupresión: 1986-1995 y 1996-2001. La curva de Kaplan-Meier mostró un aumento significativo de la supervivencia del injerto durante el periodo 1996-2001. La vida media real no censurada del injerto fue de 10,25 años en 1986-1995 y la actuarial fue de 14,58 años en 1996-2001 (p < 0,001). La tasa de pérdida del injerto fue significativamente mayor en 1986-1995, incluso con la exclusión del primer año del análisis. En 1996-2001, la disminución de la función renal fue menos pronunciada, observándose una mejor conservación a pesar de que los donantes tenían más edad y de que habían fallecido por accidente cardiovascular. El modelo parsimonioso multivariante de Cox reveló que la edad del donante, el rechazo agudo, el panel de anticuerpos reactivos, el tiempo de isquemia fría y la función retrasada del injerto se asociaban de forma significativa a un mayor riesgo de pérdida del injerto. Sin embargo, el riesgo de pérdida del injerto se vio reducido en un 21% en 1996-2001 en comparación con el periodo 1986-1995. Se observó una reducción similar (25%) al incluir el tratamiento con MMF en el modelo multivariante en lugar del periodo de estudio. La supervivencia del injerto a largo plazo mejoró significativamente en 1996-2001 frente al periodo 1986-1995, a pesar de que los donantes tenían más edad. Por lo tanto, la inmunosupresión moderna podría haber contribuido a la mejora de los resultados del transplante renal.

Abstract

We analyzed graft half-life and attrition rates in 1045 adult deceased donor kidney transplants from 1986-2001, with follow-up to 2011, grouped in two periods (1986-95 vs. 1996-01) according to immunosuppression. The Kaplan-Meier curve showed a significant increase in graft survival during 1996-2001. The uncensored real graft half-life was 10.25 years in 1986-95 and the actuarial was 14.58 years in 1996-2001 (P<0.001). The attrition rates showed a significantly greater graft loss in 1986-95, even excluding the first year from the analysis. The decline in renal function was significantly less pronounced in 1996-2001, indicating better preservation of renal function, despite the increase in donor age and stroke as the cause of donor death. The parsimonious Cox multivariate model showed donor age, acute rejection, panel reactive antibody, cold ischemia time and delayed graft function were significantly associated with a higher risk of graft loss. In contrast, the risk of graft loss fell by 21% in 1996-2001 compared with 1986-95. A similar reduction (25%) was observed when MMF treatment was entered into the multivariate model instead of study period. Long-term graft survival improved significantly in 1996-2001 compared to 1986-1995 despite older donor age. Modern immunosuppression could have contributed to the improved kidney transplant outcome.

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