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A REVIEW OF FAILED KIDNEY TRANSPLANT PATIENTS IN A SINGLE-CENTRE TRANSPLANT CLINIC, 2011 – 2015Michael Kelly, Maeve Maginn, Hatem Mansy, Iain MooreRenal Unit, City Hospitals Sunderland NHS Foundation TrustProblem: 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. ................
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