Transplante renal

: caracterização de uma população e avaliação de factores de risco para a rejeição/perda do enxerto

Abstract

Renal transplantation is now regarded as the best and most effective therapeutic alternative for kidney patients in terminal stage. Despite their high success rate, is subject to a high rate of complications, being the largest kidney transplant survival rate limiter the development of chronic graft nephropathy that can lead to loss of function of the graft. This presents multiple immunological risk factors such as compatibility of Antigen of the HLA system, occurrence of acute rejection episodes, presence of HLA Antibodies, blood transfusions, organ transplants and immune response continued to Allograft and subliminal non-immunological factors including age and the brain-dead donor type, amount of nephrons grafted on the receiver, aggression by ischemia, and the use of calcineurin inhibitors. The objectives of this work are: 1) characterize demographically a population of kidney transplanted, evaluating different variables related to the receiver, to the donor and graft; 2) evaluate, immunological and non-immunological different variables, on the receiver, donor and graft; 3) identify potential risk factors associated with graft rejection/loss. We evaluated retrospectively a transplanted population of Northern Portugal, from January 1983 to June 2010. Possible factors were analyzed for rejection/loss of the organ in the receiver, donor and graft; the variables analyzed in the receiver included: gender, age, number of pregnancies, number of transfusions, dialysis time, cause of kidney disease, the presence of anti-HLA Antibodies, late renal function and episodes of rejection; the variables analyzed in donor included: gender, age, cause of death and type of the donor; HLA system compatibility and cold ischemia time were the factors related to the transplant. Who have lost kidney function and returned to dialysis were considered as having rejected/lost the transplanted graft. Of 3220 renal transplant, 1022 (31.4%) lost the graft and 2198 (68.3%) kept functioning graft. The average length of the transplant was 166 ± 159 months. The main cause of graft loss was the chronic rejection (30.0).The main cause of graft loss was the chronic rejection (30.0). Multivariate analysis showed a strong association between graft rejection/loss and the presence of de novo antibodies (RR = 7.53; p< 0.001), late graft function (RR=2.49; p< 0.004) and pre sensitization with HLA Antibodies (RR = 2.79; p< 0.010) in this paper we identify risk factors in kidney donor and receiver associated with graft failure. Since the phenomenon of rejection/loss of the graft is multifactorial, the determination and prevention of its risk factors can contribute to a significant increase in renal graft survival and improve the quality of life in renal transplanted patients

Date of Award	2023
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Elísio Costa (Supervisor) & José Fernando Teixeira (Co-Supervisor)