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        "resumen" => "<p class="elsevierStylePara">We analyzed graft half-life and attrition rates in 1045 adult deceased donor kidney transplants from 1986-2001&#44; with follow-up to 2011&#44; grouped in two periods &#40;1986-95 vs&#46; 1996-01&#41; according to immunosuppression&#46; The Kaplan-Meier curve showed a significant increase in graft survival during 1996-2001&#46; The uncensored real graft half-life was 10&#46;25 years in 1986-95 and the actuarial was 14&#46;58 years in 1996-2001 &#40;P&#60;0&#46;001&#41;&#46; The attrition rates showed a significantly greater graft loss in 1986-95&#44; even excluding the first year from the analysis&#46; The decline in renal function was significantly less pronounced in 1996-2001&#44; indicating better preservation of renal function&#44; despite the increase in donor age and stroke as the cause of donor death&#46; The parsimonious Cox multivariate model showed donor age&#44; acute rejection&#44; panel reactive antibody&#44; cold ischemia time and delayed graft function were significantly associated with a higher risk of graft loss&#46; In contrast&#44; the risk of graft loss fell by 21&#37; in 1996-2001 compared with 1986-95&#46; A similar reduction &#40;25&#37;&#41; was observed when MMF treatment was entered into the multivariate model instead of study period&#46; Long-term graft survival improved significantly in 1996-2001 compared to 1986-1995 despite older donor age&#46; Modern immunosuppression could have contributed to the improved kidney transplant outcome&#46;</p>"
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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
Miguel González-Molinaa, Dolores Burgosa, Mercedes Cabelloa, Pedro Ruiz-Estebana, Manuel A. Rodríguezb, Cristina Gutiérreza, Verónica Lópeza, Víctor Baenac, Domingo Hernándeza
a Servicio de Nefrología, Hospital Regional Universitario Carlos Haya/IBIMA, Málaga,
b Servicio de Nefrología, Hospital Torrecárdenas, Almería,
c Servicio de Urología, Hospital Regional Universitario Carlos Haya, Málaga,
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        "resumen" => "<p class="elsevierStylePara">An&#225;lisis de la vida media del injerto y de su tasa de p&#233;rdida en 1045&#160;transplantes de donantes cad&#225;ver adultos entre 1986 y 2001&#44; con seguimiento hasta 2011&#44; clasificados en dos periodos en funci&#243;n de la inmunosupresi&#243;n&#58; 1986-1995 y 1996-2001&#46; La curva de Kaplan-Meier mostr&#243; un aumento significativo de la supervivencia del injerto durante el periodo 1996-2001&#46; La vida media real no censurada del injerto fue de 10&#44;25 a&#241;os en 1986-1995 y la actuarial fue de 14&#44;58&#160;a&#241;os en 1996-2001 &#40;p&#160;&#60;&#160;0&#44;001&#41;&#46; La tasa de p&#233;rdida del injerto fue significativamente mayor en 1986-1995&#44; incluso con la exclusi&#243;n del primer a&#241;o del an&#225;lisis&#46; En 1996-2001&#44; la disminuci&#243;n de la funci&#243;n renal fue menos pronunciada&#44; observ&#225;ndose una mejor conservaci&#243;n a pesar de que los donantes ten&#237;an m&#225;s edad y de que hab&#237;an fallecido por accidente cardiovascular&#46; El modelo parsimonioso multivariante de Cox revel&#243; que la edad del donante&#44; el rechazo agudo&#44; el panel de anticuerpos reactivos&#44; el tiempo de isquemia fr&#237;a y la funci&#243;n retrasada del injerto se asociaban de forma significativa a un mayor riesgo de p&#233;rdida del injerto&#46; Sin embargo&#44; el riesgo de p&#233;rdida del injerto se vio reducido en un 21&#37; en 1996-2001 en comparaci&#243;n con el periodo 1986-1995&#46; Se observ&#243; una reducci&#243;n similar &#40;25&#37;&#41; al incluir el tratamiento con MMF en el modelo multivariante en lugar del periodo de estudio&#46; La supervivencia del injerto a largo plazo mejor&#243; significativamente en 1996-2001 frente al periodo 1986-1995&#44; a pesar de que los donantes ten&#237;an m&#225;s edad&#46; Por lo tanto&#44; la inmunosupresi&#243;n moderna podr&#237;a haber contribuido a la mejora de los resultados del transplante renal&#46;</p>"
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Información del artículo
ISSN: 02116995
Idioma original: Español
DOI:10.3265/Nefrologia.pre2014.Jun.12327
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