Outpatient Period After Kidney Transplantation – Frequency of Complications and Their Impact on Graft and Patient Survival
Background and objective: The growing numbers of kidney transplantations in recent years mainly focus our attention on the possibilities to prolong kidney graft and recipient survival, searching for methods to minimize post-transplant complications, which may have an adverse effect on outcomes of kidney transplantation. Despite innovations in the field of immunology and modern diagnostic and therapeutic novelties in recent years, the main challenge remains the improvement of a long-term kidney transplant and recipient survival. The outpatient period is very important to long-term kidney transplant survival. The aim of our study was to analyze outpatient period complications after kidney transplantation and identify factors during the outpatient period influencing kidney transplant and recipient survival.
Materials and methods: We analyzed the rate of outpatient period complications, their dependence on the time after transplantation and influence of these complications on the graft and recipient survival in 249 renal transplant patients.
Results: The causes of recipient death during the whole outpatient period were infection 31.8% (n = 7), cardiovascular events 31.8% (n = 7), sudden death 18.2% (n = 4), other 9.1% (n = 2) and unknown reasons 9.1% (n= 2). The reasons of graft loss during the whole outpatient period were chronic allograft nephropathy/glomerular diseases 42.8% (n = 13), infection 37.0% (n = 10), acute rejection 7.4% (n = 2) and other 7.4% (n = 2). Infectious complications were the most common complications of the outpatient period. Urinary tract infection was diagnosed in more than a half of our patients (57.5%) and more often during the first year after kidney transplantation (44.1%). Sepsis was diagnosed in 48 recipients (19.3%). Sepsis (log-rank P = 0.012), urinary tract infections (log-rank P = 0.024), acute rejection (log-rank P = 0.032) and pneumonia (log-rank P = 0.024) which occurred during the outpatient period were significantly associated with worse overall graft survival. The occurrence of sepsis during the whole outpatient period and during the first year after transplantation was significantly associated with worse recipient survival (log-rank P = 0.014 and
log-rank P = 0.004, respectively).
Conclusions: Infectious complications were the most common complications of the outpatient period. Urinary tract infections were diagnosed in more than a half of our patients after kidney transplantation. During the first year after transplantation, sepsis was diagnosed in 11.6% of the recipients and the main gate of infection was urinary tract. Acute rejection was diagnosed in 12% of our recipients during the outpatient period. Outpatient post-transplant period complications, such as sepsis, acute rejection, pneumonia and urinary tract infections (first year after transplantation), were significantly negatively associated with graft survival. Recipient survival was negatively associated with sepsis. The main reasons for graft loss in our recipients were infectious complications, chronic allograft nephropathy, and glomerular diseases. The main reasons for mortality after kidney transplantation were infectious complications and cardiovascular events.
Correspondence to E. Dalinkevičienė Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, 50161 Kaunas, Lithuania E-mail address: firstname.lastname@example.org