Introduction
Patients and methods
Data collection and study population
Outcome measures
Body mass index
Glomerular filtration rate
Standard and expanded criteria donors
Organ procurement and transplantation
Immunosuppression
Statistical analysis
Results
Baseline characteristics
Variables | Body mass index | P-value | ||
---|---|---|---|---|
18.5–24.9 (N = 304) | 25–29.9 (N = 205) | ≥ 30 (N = 69) | ||
Recipient | ||||
Age, years | 49.5 ± 14.2 | 55.9 ± 11.9 | 59.6 ± 12.2 | < 0.001 |
Gender, male/ female (%) | 182 (59.9)/ 122 (40.1) | 135 (65.9)/ 70 (34.1) | 46 (66.7)/ 23 (33.3) | 0.304 |
BMI, kg/m2 | 22.4 ± 1.6 | 27.1 ± 1.3 | 31.9 ± 2.4 | < 0.001 |
Time on the waiting list, months | 17.7 ± 28.6 | 18.4 ± 30.2 | 23.0 ± 30.3 | 0.574 |
Dialysis duration, months | 47.3 ± 35.5 | 46.4 ± 36.2 | 55.6 ± 33.6 | 0.763 |
Cause of ESRD (%) | ||||
Glomerulonephritis | 153 (50.0) | 67 (32.7) | 17 (24.6) | < 0.001 |
Non-glomerulonephritis, cystic kidney disease/ interstitial nephritis/ diabetes mellitus/ others/ unknown | 47 (15.5)/ 28 (9.2)/ 3 (1.0)/ 50 (16.4)/ 24 (7.9) | 39 (19.0)/ 26 (12.7)/ 16 (7.8)/ 42 (20.4)/ 15 (7.3) | 15 (21.7)/ 7 (10.1)/ 10 (14.6) /16 (23.2)/ 4 (5.8) | |
Comorbidity (%) | ||||
Diabetes mellitus | 26 (8.6) | 30 (14.6) | 22 (31.9) | < 0.001 |
Hypertension | 276 (90.8) | 193 (94.1) | 67 (97.1) | 0.118 |
Coronary disease | 35 (11.5) | 38 (18.5) | 12 (17.4) | 0.072 |
PVD | 11 (3.6) | 16 (7.8) | 6 (8.7) | 0.071 |
Donor | ||||
Age, years | 51 ± 15.6 | 53 ± 17.3 | 56 ± 16.4 | 0.069 |
Gender, male/ female (%) | 165 (54.3)/ 139 (45.7) | 114 (55.6)/ 91 (44.4) | 41 (59.4)/ 28 (40.6) | 0.737 |
BMI, kg/m2 | 25.1 ± 4.3 | 25.0 ± 3.7 | 24.4 ± 3.0 | 0.200 |
Organ quality, excellent/ good/ acceptable/ unknown (%) | 14 (4.6)/ 216 (71.1)/ 10 (3.3)/ 64 (21.1) | 17 (8.3)/ 136 (66.3)/ 11 (5.4)/ 41 (20.0) | 5 (7.2)/ 50 (72.5)/ 4 (5.8)/ 10 (14.5) | 0.329 |
Comorbidity (%) | ||||
Diabetes mellitus | 22 (7.2) | 13 (6.3) | 5 (7.2) | 0.921 |
Hypertension | 83 (27.3) | 71 (34.6) | 25 (36.2) | 0.129 |
Donor type, LD/ SCD/ ECD (%) | 62 (20.4)/ 146 (48.0)/ 96 (31.6) | 26 (12.7)/ 100 (48.8)/ 79 (38.5) | 5 (7.2)/ 32 (46.4)/ 32 (46.4) | 0.014 |
Cause of death DD (%) | ||||
CVA | 125 (51.7) | 92 (51.4) | 35 (54.7) | 0.571 |
Non-CVA, anoxia/ ischemia/ polytrauma/ others | 18 (7.4)/ 28 (11.6)/ 38 (15.7)/ 8 (3.3) | 18 (10.1)/ 16 (8.9)/ 25 (14.0)/ 13 (7.3) | 7 (10.9)/ 4 (6.3)/ 9 (14.1)/ 3 (4.7) | |
Transplant | ||||
Transplant era (%) | ||||
1993–2001/ 2002–2009/ 2010–2017 | 108 (35.5)/ 105 (34.5)/ 91 (29.9) | 64 (31.2)/ 71 (34.6)/ 70 (34.1) | 13 (18.8)/ 26 (37.7)/ 30 (43.5) | 0.079 |
HLA mismatches ≥ 3 (%) | 143 (47.0) | 108 (52.7) | 40 (58.0) | 0.271 |
PRA (%) | 50 (16.4) | 29 (14.1) | 10 (14.5) | 0.753 |
Gender mismatch | 153 (50.3) | 109 (53.29 | 31 (44.9) | 0.462 |
CIT, hours | 11.5 ± 7.1 | 10.6 ± 6.6 | 11.4 ± 5.7 | 0.999 |
WIT, minutes | 40 ± 19.9 | 40 ± 15.8 | 45 ± 23.8 | 0.312 |
Induction therapy, ATG/ ILR2-RA | 15 (4.9)/ 101 (33.2) | 7 (3.4)/ 68 (33.2) | 2 (2.9)/ 26 (37.7) | 0.582 |
Intra-operative complications (%) | ||||
Bleeding | 11 (3.6) | 10 (4.9) | 3 (4.3) | 0.780 |
Thrombosis artery | 8 (2.6) | 6 (2.9) | 3 (4.3) | 0.748 |
Thrombosis vein | 4 (1.3) | 2 (1.0) | 1 (1.4) | 0.925 |
Hyperacute rejection | 3 (1.0) | 0 | 0 | 0.257 |
Duration of surgery, minutes | 172 ± 46.0 | 179 ± 53.2 | 194 ± 64.8 | < 0.001 |
Immunosuppression (%) | ||||
CNI, Tac/ CsA | 170 (55.9)/ 128 (42.1) | 122 (59.5)/ 75 (36.6) | 47 (68.1)/ 22 (31.9) | 0.400 |
mTOR inhibitor, Ever/ Siro | 1 (0.3)/ 8 (2.6) | 0/ 4 (2.0) | 1 (1.4)/ 1(1.4) | 0.471 |
CNI + mTOR inhibitor | 9 (3.0) | 4 (2.0) | 2 (2.9) | 0.788 |
AM drug, AZA/ MMF | 23 (7.6)/ 262 (86.2) | 8 (3.9)/ 180 (87.8) | 3 (4.3)/ 63 (91.3) | 0.502 |
Steroids, prednisolone | 295 (96.7) | 191 (93.2) | 69 (100.0) | 0.134 |
Follow-up, years | 7.6 ± 6.0 | 6.7 ± 5.9 | 5.5 ± 4.3 | 0.005 |
Outcome
Variables | Body mass index | P-value | ||
---|---|---|---|---|
18.5–24.9 (N = 304) | 25–29.9 (N = 205) | ≥ 30 (N = 69) | ||
Outcome Parameters | ||||
Surgical | ||||
RBC substitution (%) | 83 (27.3) | 55 (26.8) | 17 (24.6) | 0.903 |
FFP substitution (%) | 25 (8.2) | 15 (7.3) | 4 (5.8) | 0.775 |
Time on ICU, days | 5 ± 5.0 | 5 ± 6.0 | 5 ± 14.6 | 0.079 |
Post-operative complications (%) | ||||
Deep vein thrombosis | 3 (1.0) | 4 (2.0) | 2 (2.9) | 0.435 |
Occlusion or thrombosis | ||||
Renal artery | 5 (1.3) | 4 (2.0) | 2 (2.9) | 0.631 |
Renal vein | 8 (2.6) | 3 (1.5) | 1 (1.4) | 0.615 |
Pulmonary embolism | 2 (0.7) | 1 (0.5) | 0 | 0.788 |
Secondary bleeding/ hematoma | 62 (20.4) | 39 (19.0) | 16 (23.2) | 0.754 |
Wound infection | 48 (15.8) | 45 (22.0) | 30 (43.5) | < 0.001 |
Fascial dehiscence | 1 (0.3) | 5 (2.4) | 3 (4.3) | 0.023 |
Urine leakage | 12 (4.0) | 3 (1.5) | 2 (2.9) | 0.266 |
Lymphocele | 37 (12.2) | 19 (9.3) | 16 (23.2) | 0.010 |
Clavien-Dindo ≥ 3b (%) | 67 (22.0) | 51 (24.9) | 26 (37.7) | 0.025 |
Renal | ||||
INF (%) | 11 (3.6) | 16 (7.8) | 5 (7.2) | 0.108 |
DGF (%) | 72 (23.7) | 47 (22.9) | 32 (46.4) | < 0.001 |
Acute rejection, (%) | 95 (31.3) | 66 (32.2) | 23 (33.3) | 0.718 |
GFR (mL/ min) | ||||
POD7 | 36.5 ± 42.5 | 45.5 ± 40.6 | 18.1 ± 28.3 | 0.002 |
POD14 | 67.6 ± 46.8 | 62.0 ± 36.8 | 56.3 ± 35.6 | 0.041 |
POM1 | 82.5 ± 36.5 | 76.7 ± 37.9 | 78.9 ± 35.9 | 0.160 |
POM6 | 85.4 ± 32.3 | 80.9 ± 35.7 | 93.6 ± 33.9 | 0.704 |
Metabolic | ||||
NODAT (%) | 15 (4.9) | 12 (5.8) | 8 (11.6) | 0.110 |
Hospitalisation, days | 22 ± 16.1 | 25 ± 16.2 | 33 ± 21.5 | < 0.001 |
Post-operative mortality 30 days (%) | 3 (1.0) | 3 (1.5) | 0 | 0.579 |
Post-operative mortality 90 days (%) | 6 (2.0) | 5 (2.4) | 0 | 0.436 |
Variables | Body mass index | ||||||
---|---|---|---|---|---|---|---|
18.5–24.9 | 25–29.9 | ≥ 30 | |||||
Univariate analysis | Univariate analysis | ||||||
OR | 95% CI | P-value | OR | 95% CI | P-value | ||
Intraoperative complications | |||||||
Bleeding (1) | ref | 1.366 | 0.569–3.278 | 0.485 | 1.211 | 0.329–4.461 | 0.774 |
Thrombosis artery or vein (1) | ref | 0.988 | 0.397–2.461 | 0.980 | 1.106 | 0.304–4.030 | 0.879 |
Duration of surgery (1) | ref | 1.391 | 0.960–2.016 | 0.081 | 2.765 | 1.489–5.134 | 0.001 |
Ventilation time (1) | ref | 1.524 | 0.871–2.665 | 0.140 | 2.510 | 1.236–5.097 | 0.011 |
Time on ICU (1) | ref | 0.756 | 0.528–1.082 | 0.126 | 1.082 | 0.632–1.851 | 0.773 |
Postoperative complications | |||||||
Vascular (1) | ref | 0.897 | 0.586–1.374 | 0.671 | 1.339 | 0.747–2.402 | 0.327 |
Surgical (1) | ref | 1.131 | 0.783–1.633 | 0.512 | 3.240 | 1.880–5.585 | < 0.001 |
Urological surgical (1) | ref | 0.361 | 0.101–1.297 | 0.118 | 0.726 | 0.159–3.322 | 0.680 |
Clavien-Dindo ≥ 3 (%) | ref | 1.171 | 0.772–1.777 | 0.457 | 2.148 | 1.225–3.734 | 0.008 |
Hospitalisation (1) | ref | 1.222 | 0.856–1.743 | 0.269 | 2.456 | 1.400–4.307 | 0.002 |
Renal outcome | |||||||
INF (1) | ref | 2.232 | 1.014–4.914 | 0.046 | 2.092 | 0.702–6.234 | 0.185 |
DGF (1) | ref | 0.946 | 0.622–1.440 | 0.796 | 2.827 | 1.640–4.875 | < 0.001 |
Acute rejection, all (2) | ref | 1.121 | 0.861–1.458 | 0.397 | 1.494 | 0.861–2.171 | 0.035 |
Graft failure (death-censored) (2) | ref | 1.113 | 0.767–1.617 | 0.573 | 2.405 | 1.512–3.827 | < 0.001 |
NODAT (1) | ref | 1.198 | 0.549–2.615 | 0.650 | 2.527 | 1.026–6.224 | 0.044 |
Graft and patient survival
Variables | Body mass index | P-value | ||
---|---|---|---|---|
18.5–24.9 (N = 304) | 25–29.9 (N = 205) | ≥ 30 (N = 69) | ||
Cause of graft loss (%) | ||||
Death | 23 (7.6) | 13 (6.3) | 4 (5.8) | 0.125 |
Graft failure | 72 (23.7) | 48 (23.4) | 28 (40.6) | 0.007 |
Cause of graft failure (%) | ||||
Vascular | 7 (9.5) | 8 (16.7) | 3 (10.3) | 0.505 |
Acute or chronic rejection | 29 (39.2) | 13 (27.1) | 7 (24.1) | 0.193 |
Recurrence of renal disease | 4 (5.4) | 2 (4.2) | 1 (3.4) | 0.893 |
Chronic allograft nephropathy | 19 (25.7) | 8 (16.7) | 6 (20.7) | 0.452 |
Infection | 6 (8.1) | 5 (10.4) | 9 (31.0) | 0.006 |
Other | 9 (12.2) | 12 (25.0) | 3 (10.3) | 0.130 |
A | ||||||||
Variables | Delayed graft function (1) | Surgical complications (1) | ||||||
UVA | Multivariate analysis | UVA | Multivariate analysis | |||||
P-value | OR | 95% CI | P-value | P-value | HR | 95% CI | P-value | |
Recipient | ||||||||
Age | 0.001 | 1.535 | 1.003–2.350 | 0.048 | 0.040 | NS | NS | NS |
BMI | ||||||||
18.5–24.9 vs. 25–29.9 | 0.796 | 0.821 | 0.530–1.273 | 0.379 | 0.512 | 1.061 | 0.631–1.784 | 0.823 |
18.5–24.9 vs. ≥ 30 | < 0.001 | 2.400 | 1.365–4.219 | 0.002 | < 0.001 | 2.441 | 1.182–5.038 | 0.016 |
Diabetes mellitus | 0.179 | 0.075 | ||||||
Hypertension | 0.512 | 0.388 | ||||||
Coronary disease | 0.043 | NS | NS | NS | 0.202 | |||
Donor | ||||||||
Age | 0.077 | 0.296 | ||||||
Donor type, LD/ DD | 0.002 | 2.118 | 1.091–4.112 | 0.027 | 0.071 | |||
Cause of death, CVA/ non-CVA | 0.960 | 0.457 | ||||||
Diabetes mellitus | 0.358 | 0.700 | ||||||
Hypertension | 0.013 | NS | NS | NS | 0.027 | NS | NS | NS |
ECD | 0.001 | 1.538 | 1.016–2.328 | 0.042 | 0.194 | |||
Transplant | ||||||||
WIT | 0.294 | 0.003 | 1.906 | 1.183–3.071 | 0.008 | |||
Duration of surgery | 0.017 | NS | NS | NS | 0.380 | |||
Acute rejection | N/A | 0.005 | 2.006 | 1.084–3.713 | 0.027 | |||
B | ||||||||
Variables | Rejection (treated) (2) | Graft failure (death-censored) (2) | ||||||
UVA | Multivariate analysis | UVA | Multivariate analysis | |||||
P-value | HR | 95% CI | P-value | P-value | HR | 95% CI | P-value | |
Recipient | ||||||||
Age | 0.146 | 0.051 | ||||||
BMI | ||||||||
18.5–24.9 vs. 25–29.9 | 0.397 | NS | NS | NS | 0.573 | NS | NS | NS |
18.5–24.9 vs. ≥ 30 | 0.035 | NS | NS | NS | < 0.001 | NS | NS | NS |
Diabetes mellitus | 0.034 | NS | NS | NS | 0.001 | 1.709 | 1.067–2.736 | 0.026 |
Hypertension | 0.053 | < 0.001 | 2.565 | 1.514–4.344 | 0.001 | |||
Coronary disease | 0.283 | 0.194 | ||||||
Donor | ||||||||
Age | 0.004 | NS | NS | NS | < 0.001 | 2.725 | 1.841–4.033 | < 0.001 |
Donor type, LD/ DD | 0.046 | NS | NS | NS | 0.004 | NS | NS | NS |
Cause of death, CVA/ non-CVA | 0.191 | 0.031 | NS | NS | NS | |||
Diabetes mellitus | 0.089 | 0.011 | NS | NS | NS | |||
Hypertension | 0.182 | < 0.001 | NS | NS | NS | |||
ECD | 0.004 | 1.448 | 1.131–1.852 | 0.003 | < 0.001 | 3.095 | 2.115–4.530 | < 0.001 |
Transplant | ||||||||
WIT | 0.333 | 0.497 | ||||||
Duration of surgery | 0.144 | 0.375 | ||||||
Acute rejection | N/A | < 0.001 | 2.709 | 1.830–4.011 | < 0.001 |