Iranian Model of Renal Allograft Transplantation In 3028 Recipients: Survival and Risk Factors

BackgroundConsidering the organ shortage crisis for renal transplantation worldwide, assessing the risk factors to establish better allocation strategies to improve graft survival seems to be crucial.ObjectivesWe aimed to evaluate the risk factors influencing graft and patient survival after renal transplantation to construct a model of prognostic factors for living renal transplantation (LRT), namely living unrelated renal transplantation (LURT).MethodsWe designed a retrospective multicenter survey including medical record review of 3028 patients who received renal transplants at 2 hospitals between July 1984 and December 2005. We assessed the impact on graft survival of recipient/donor relationship, recipient age and gender, donor age and gender, and viral hepatitis B and C infections.ResultsAmong 3028 recipients, including 94.8% primary grafts, 63.4% were men, mean ± SE of age 36.4 ± 0.3 years, with mostly end-stage renal disease due to diabetes mellitus, hypertension, or glomerulonephritis. One-, 5-, 10- and 15-year graft survival rates were 85.4%, 68.3%, 46.4%, and 23.8%, respectively. Patient survival rates were 93.4%, 87.5%, 79.4%, and 66.4% at the above intervals, respectively. Donor age (relative hazard [RH], 1.024; P < .001), unrelated donors (RH, 1.7; P < .001), and hepatitis C virus (HCV) infection (RH, 2.65; P < .001) were the only significant factors affecting graft survival.ConclusionIncreased donor age, unrelated donor, and HCV infection were significant factors negatively impacting graft survival; thus, proper management of these factors may lead to better graft and patient survival.