P80
A REVIEW OF FAILED KIDNEY TRANSPLANT PATIENTS IN A SINGLECENTRE TRANSPLANT CLINIC, 2011 – 2015
Michael Kelly, Maeve Maginn, Hatem Mansy, Iain Moore
Renal Unit, City Hospitals Sunderland NHS Foundation Trust
Problem: Kidney transplantation offers end-stage renal disease (ESRD)patients major
benefits in both survival and quality of life. As we strive to provide best possible outcomes
for patients, it is vitally important to learn from cases of transplant failure.
Purpose: We wished to identify how and why kidney transplants fail in a single-centre DGH
follow-up clinic, to identify common factors involved in reduced graft survival and to look at
potential areas where we could improve care for our Kidney Transplant Recipient (KTR)
population. We have 221 renal transplant recipients under review at our transplant clinic.
Design: We looked at all incident graft failures or deaths in our clinic from 2011-2015. We
evaluated factors including graft survival, age at transplantation, index disease, cause for graft
loss or death, immunosuppression (IS) regimen, CKD-T trajectory and biopsy results.
Findings: During the study period 19 patients died and 21 lost graft function. The most
common cause for graft loss wasdeath with a functioning graft (15), followed by Interstitial
Fibrosis/Tubular Atrophy (IF/TA) (12).Mean graft survival was 9.2 years, with a wide range
(128 days to 24 years) and standard deviation of 7.4 years.78 new KTRs were added to the
clinic during the study period.
Factors common to the upper quartile for graft survival were: live-donor transplant, younger
age at transplant, glomerulonephritis as index disease, first transplant andnot using
Tacrolimus (TAC).
Factors identified in the lower quartiles for graft survival were: Older recipient, Diabetes as
index disease, poor compliance with IS and treatment with TAC. Poor IS compliance,as
evidenced by unstable Calcineurin Inhibitor (CNI) levels, were found in some younger
patients in the 3rd and 4th quartiles for graft survival.
Of the 19 patients who died, 15 had previously stable graft function. The leading causes of
death were Cardiovascular (5), Infection (4), and Malignancy (4).
Renal biopsy results were available for 11 of the 21 patients who lost function. While most
showed IF/TA, 2 showed late-onset acute cellular rejection and 2 recurrent IgA Nephropathy.
Conclusion: Our data are consistent with previous published series. Younger, fitter KTRs
receiving their first transplant enjoy longer graft survival than older patients, particularly
those with diabetes. Our findings do not provide an estimate of overall graft survival, as only
failed grafts were included in this study. The relatively long graft survival ofKTRs not treated
with TAC probably reflects drug unavailability orthat TAC was not part of our local IS
protocol at theirtime of transplant.
Relevance: This series provides a snapshot of our local practice but identifies general areas of
concern common to all members of the renal team. We still need to find more effective ways
to improve IS compliance, to optimise cardiovascular risk factors, to screen for malignancy,
and to recognise sepsis earlier in our immunosuppressed patients.