Department of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, Western Cape, South Africa.
Kidney and Hypertension Research Unit, University of Cape Town, Western Cape, South Africa.
PLoS One. 2019 Jan 25;14(1):e0211189. doi: 10.1371/journal.pone.0211189. eCollection 2019.
Access to dialysis and transplantation in the developing world remains limited. Therefore, optimising renal allograft survival is essential. This study aimed to evaluate clinical outcomes and identify poor prognostic factors in the renal transplant programme at Groote Schuur Hospital [GSH], Cape Town. .
Data were collected on all patients who underwent a kidney transplant at GSH from 1st July 2010 to the 30 June 2015. Analyses were performed to assess baseline characteristics, graft and patient survival, as well as predictors of poor outcome. .
198 patients were transplanted. The mean age was 38 +/- 10.5 years, 127 (64.1%) were male, and 86 (43.4%) were of African ethnicity. Deceased donor organs were used for 130 (66.7%) patients and living donors for 65 (33.3%). There were > 5 HLA mismatches in 58.9% of transplants. Sepsis was the commonest cause of death and delayed graft function [DGF] occurred in 41 (21.4%) recipients. Patient survival was 90.4% at 1 year and 83.1% at 5 years. Graft survival was 89.4% at 1 year and 80.0% at 5 years. DGF (HR 2.83 (1.12-7.19), p value = 0.028) and recipient age > 40 years (HR 3.12 (1.26-7.77), p value = 0.014) were predictors of death.
Despite the high infectious burden, stratified immunosuppression and limited tissue typing this study reports encouraging results from a resource constrained transplant programme in South Africa. Renal transplantation is critical to improve access to treatment of end stage kidney disease where access to dialysis is limited.
在发展中国家，透析和移植的机会仍然有限。因此，优化肾移植的存活率至关重要。本研究旨在评估开普敦格罗特舒尔医院（GSH）肾移植项目的临床结果，并确定不良预后因素。
收集了 2010 年 7 月 1 日至 2015 年 6 月 30 日期间在 GSH 接受肾移植的所有患者的数据。进行了分析，以评估基线特征、移植物和患者存活率以及不良预后的预测因素。
198 例患者接受了移植。平均年龄为 38 +/- 10.5 岁，127 例（64.1%）为男性，86 例（43.4%）为非洲裔。130 例（66.7%）患者使用了已故供体器官，65 例（33.3%）患者使用了活体供体器官。58.9%的移植存在> 5 个 HLA 错配。感染是死亡的最常见原因，41 例（21.4%）受者发生延迟移植物功能。1 年时患者存活率为 90.4%，5 年时为 83.1%。1 年时移植物存活率为 89.4%，5 年时为 80.0%。DGF（HR 2.83（1.12-7.19），p 值= 0.028）和受者年龄> 40 岁（HR 3.12（1.26-7.77），p 值= 0.014）是死亡的预测因素。
尽管感染负担较高，免疫抑制分层和组织配型有限，但这项来自南非资源有限的移植项目的研究报告了令人鼓舞的结果。肾移植对于改善终末期肾病治疗的机会至关重要，在这些地方，透析的机会有限。
