Long-term outcomes and prognostic factors in kidney transplant recipients in Jakarta, Indonesia: a cohort study

Abstract

ObjectivesTo determine the long-term survival rates and prognostic factors in kidney transplant (KT) recipients in Jakarta, Indonesia.DesignRetrospective cohort study.SettingA KT centre in Jakarta.ParticipantsWe enrolled 754 consecutive adult recipients who underwent KT between 2010 and 2020.Main outcome measuresRates of 10-year patient, all-cause and death-censored graft survival and their prognostic factors in KT recipients.ResultsThe 10-year patient survival, all-cause survival and death-censored graft survival rates of KT recipients were 74%, 68% and 81%, respectively. The prognostic factors for poor patient survival were a pretransplant dialysis duration>24 months (HR 1.64, 95% CI, 1.08 to 2.49; p=0.02), cardiovascular disease (HR 1.59, 95% CI, 1.11 to 2.31; p=0.01), delayed graft function (DGF) (HR 4.94, 95% CI, 2.76 to 8.82; p<0.001), post-transplant infection (HR 2.63, 95% CI, 1.56 to 4.43; p<0.001) and acute rejection (HR 2.49, 95% CI, 1.20 to 5.15; p=0.01). All-cause graft survival was prognosticated by a pretransplant dialysis duration>24 months (HR 1.74, 95% CI, 1.15 to 2.47; p=0.007), cardiovascular disease (HR 1.65, 95% CI, 1.18 to 2.33; p=0.004), DGF (HR 5.39, 95% CI, 3.13 to 9.28; p<0.001), post-transplant infection (HR 2.46, 95% CI, 1.05 to 4.02; p<0.001) and acute rejection (HR 4.18, 95% CI, 2.23 to 7.84; p<0.001). Factors associated with poor death-censored graft survival were a pretransplant dialysis duration >24 months (HR 2.19, 95% CI, 1.32 to 3.63; p=0.002), cardiovascular disease (HR 1.65, 95% CI, 1.02 to 2.68; p=0.04) and acute rejection (HR 5.52, 95% CI, 2.80 to 10.83; p<0.001).ConclusionsThe survival rates of KT recipients are prognosticated by pretransplant dialysis duration, cardiovascular disease, DGF, post-transplant infection and acute rejection. Stricter eligibility criteria for recipients, more sensitive cross-match testing methods and better infection management strategies may be beneficial for improving the survival rates.

Distinct clinical profiles and post-transplant outcomes among kidney transplant recipients with lower education levels: uncovering patterns through machine learning clustering

“…Kidney transplant recipients with PRA of >50% had significantly higher risk of overall and death-censored graft failure and all-cause mortality independent of acute rejection, age and time on dialysis [ 39 ]. Compared to cluster 2, only cluster 3 showed a higher risk of 1-year acute rejection, a known risk factor for reduced death-censored graft survival [ 40 ]. Cluster 4 recipients were characterized by older, diabetic patients, with longer dialysis duration preceding transplantation.…”

“…Cluster 4 recipients were characterized by older, diabetic patients, with longer dialysis duration preceding transplantation. Limiting time on dialysis is beneficial and a pretransplant dialysis duration >24 months has been found to be a significant risk factor associated with poor death-censored graft survival [ 40 ]. Regardless of the origin of the donor organ, adjusted mortality rates are 75% higher with rates of adjusted graft losses 25% higher in diabetic recipients [ 41 , 42 ].…”

“…However, this cluster was notably characterized by non-ECD deceased donors, longer pretransplant dialysis duration exceeding 3 years, and higher incidences of kidney on pump machine usage and delayed graft function. These factors likely contribute to the observed inferior outcomes in cluster 1 [ 35 , 36 , 40 , 45 ].…”

Clinically relevant drug-drug interactions of tacrolimus in the first week post-kidney transplantation recipients

“…However, more data that explicitly focused on immunosuppressant DDIs, particularly in Indonesian KT recipients, were required. According to the growing number of KT procedures performed in Indonesia (Marbun et al, 2022) and the increasing complexity of medication regimens in KT recipients (Stemer and Lemmens-Gruber, 2010), understanding the prevalence and associated risk factors of immunosuppressant DDIs during the early post-KT period is crucial (Amkreutz et al, 2017). This study filled the knowledge gap by identifying the prevalence of clinically relevant immunosuppressant DDIs focusing on tacrolimus and determining the risk factors associated with an increased likelihood of such interactions in KT recipients the first week after transplantation to consider the safety and effectiveness of immunosuppressive therapy.…”