Predictors and outcomes of allograft dysfunction among kidney transplant recipients at Muhimbili National Hospital

Abstract

Background: Kidney transplantation is a Renal Replacement Therapy modality of choice for ESRD. Renal allograft loss remains an area of concern. In most native kidney diseases, glomerular filtration rate (GFR) declines progressively over time in renal transplant recipients. Monitoring changes in GFR is the recommended method for assessing the progression of kidney disease, aiming at delaying graft loss and maximize graft survival by identifying and deterring modifiable factors. Rationale: Identifying predictors of poor allograft function will help clinicians in selecting donor-recipient pairs that will maximize allograft survival as well as patients’ survival and quality of life. No study on the subject has been done in our country and there is tendency of some patients to return to chronic dialysis within a year of transplant. Hence this study was set to determine predictor of allograft dysfunction among renal recipients Methodology: Conducted a retrospective study at the Renal Transplant Clinic at Muhimbili National Hospital (MNH). Attendees of the clinic are patients who underwent renal transplantation abroad as of current transplant services are not available in the country. The Renal Transplant Clinic at the MNH runs a live-related donor Pre-Transplant Clinic and a lifelong follow-up for post kidney transplant recipients. A total of 182 recipients who were transplanted with minimum of at least 3 months post-transplant were included in study. Using questioner factors at time 0, 3,6,12 month post-transplant such as recipients’ and donors’ BMI, gender, proteinuria, eGFR change, elevated blood pressure and episode of allograft rejection were recorded and MDRD to asses for eGFR. All these factors were obtained from patients’ files supplemented with discharge summary from transplant center. The association between graft function and predictors was assessed by logistic regression. Outcome variables were; development of ESRD, return to dialysis, repeat Transplant, allograft dysfunction (defined as eGFR<60ml/min/1.73sqm or death with a functioning graft. Factors with P-value < 0.05 was considered significant. Results: Of 182 recipients, 146 (80.2%) were males. The mean age was 44.5(±12.5) years. Among donors, 97 (53%) were males with mean age of 35(±9) years whereby three quarters of the donors, 130(71%) were first degree relatives. Prevalence of allograft dysfunction at one year was 37.4%. Eleven recipients (6%) died with functioning graft within the first year of kidney transplant. On regression model; systolic blood pressure (SBP) of ≥140mmHg, proteinuria, and change of GFR emerged as significant predictors of allograft dysfunction. Conclusion: The burden of allograft dysfunction in the 1st year of kidney transplantation is high among patients attending post-transplant clinic at MNH. Monitoring post-transplant blood pressure, proteinuria and rate of change in GFR can help in regressing graft dysfunction following transplant. Recommendation: Timely and good post-transplant care on altering risk factor of graft dysfunction will increase graft and patient survival.