Review of Adult Kidney Transplant Recipients at Charlotte Maxeke Johannesburg Academic Hospital Between January 2012 to January 2020

Abstract

Background: Kidney transplantation is a lifeline for individuals with end-stage kidney failure, offering quality of life, financial and survival benefit over chronic dialysis. Kidney transplantation is complex and dependent on multiple donor and recipient factors. Ensuring longevity of future allografts requires understanding of limitations to previous allografts. Objectives: Review the most common outcomes encountered in KTR at a state hospital in Gauteng, South Africa Methodology: This was a single centre retrospective record review of all first-time adult renal transplant recipients from 01 January 2012 to 31st January 2020. Data collected included demographic and clinical parameters. Complications post- transplantation were noted. Outcome end points were recipient death and graft loss (defined by a need to return to dialysis). Results: One-hundred and sixty-seven (167) patients over 18 years old received renal transplants at our facility between 1 January 2012 and 31 January 2020, 140 were included, of which 94 (67.1%) were male and 46 (32.9%) were female. The mean (SD) age at transplant was 41.9 years (10.5 years). Hypertension was noted as the principal aetiology for renal failure in 81 (57.9%) patients. One-hundred and twenty-eight (128, 91.4%) received a cadaveric kidney transplant and 12 (8.6%) received a kidney from a living donor. Median time to discharge was 18 days (IQR 11-32 days). 63 (45.0%) patients experienced delayed graft function, of which 45 (71%) received dialysis support. 49 (35%) patients experienced graft loss with a median time to loss of 30 months (IQR 6-52 months). Anaemia and delayed graft function were significant risk factors for graft loss, (p<0.001). Antibody-mediated v | P a g e rejection, T-cell mediated rejection and BK nephropathy all proved significant risk factors for graft loss (p<0.001, p=0.002, and p=0.003 respectively). Other complications included 39 (27.9%) KTR developed post-transplant diabetes, and 8 malignancies occurred in 7 (5.0%) KTR. Thirty-nine (27.9%) patients demised throughout the study period the primary cause of death was sepsis with 21 (53.9%) deaths. Conclusion: Sepsis was a major cause of death and graft loss. Fifty-five percent (55%) of recipients had a functioning graft at 5 years. Further studies are required to determine factors influencing long term graft outcomes in our population.