تحلیل بقای 8 ساله‌ی پیوند کلیه و تعیین عوامل مؤثر بر آن در بیماران پیوند شده در بیمارستان نور اصفهان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه آمار و اپیدمیولوژی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی شهید صدوقی، یزد، ایران

2 استاد، مرکز تحقیقات بیماری‌های کلیوی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 استادیار، مرکز تحقیقات بیماری‌های کلیوی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 استادیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی شهید صدوقی، یزد، ایران

5 دانشجوی کارشناسی ارشد، گروه آمار و اپیدمیولوژی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی شهید صدوقی، یزد، ایران

چکیده

مقدمه: پیوند کلیه، درمان انتخابی بیشتر بیماران مبتلا به بیماری پیشرفته کلیه می‌باشد. بنابراین، تحلیل بقای پیوند کلیه دارای اهمیت است. هدف از انجام این مطالعه، تعیین میزان بقای تجمعی کلیه‌ی پیوندی و تعیین عوامل مؤثر بر آن بود.روش‌ها: این مطالعه به صورت هم‌گروهی تاریخی و شامل اطلاعات 381 بیمار مبتلا به End stage renal disease (ESRD) بود که از آذر 1386 تا پایان اسفند 1394 در بیمارستان نور اصفهان تحت جراحی پیوند کلیه قرار گرفتند. برای انجام محاسبات آماری، از روش Kaplan-Meier، آزمون Log rank و مدل رگرسیونی Cox استفاده شد. تحلیل داده‌ها با استفاده از نرم‌افزار R نسخه‌ی 0-1-3 انجام و 050/0 > P به عنوان سطح معنی‌داری در نظر گرفته شد.یافته‌ها: با استفاده از روش Kaplan–Meier میزان بقای 1، 3، 5 و 8 ساله‌ی کلیه‌ی پیوندی به ترتیب 7/98، 3/93، 9/86 و 9/83 درصد برآورد گردید. نتایج حاصل از مدل رگرسیونی Cox نشان داد که مدت زمان دیالیز قبل از پیوند (050/0 ≥ P) و مقدار کراتینین زمان ترخیص (050/0 ≥ P) با بقای پیوند کلیه ارتباط معنی‌داری داشت.نتیجه‌گیری: میزان بقای پیوند محاسبه شده برای این مرکز در مقایسه با سایر مراکز پیوند مقدار رضایت‌بخشی داشت و کراتینین زمان ترخیص و مدت زمان دیالیز قبل از پیوند، از عوامل تأثیرگذار بر بقای پیوند بودند.

کلیدواژه‌ها

عنوان مقاله [English]

8-Year Survival Analysis of Kidney Transplantation and Determining the Factors Affecting it in Kidney-Transplanted Patients in Noor Hospital in Isfahan, Iran

نویسندگان [English]

  • Mohsen Askarishahi 1
  • Shahrzad Shahidi 2
  • Abdolamir Atapoor 3
  • Roya Hemayati 4
  • Sajedeh Zeynali 5
1 Assistant Professor, Department of Biostatistics and Epidemiology, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Professor, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant Professor, Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Assistant Professor, Department of Internal Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5 MSc Student, Department of Biostatistics and Epidemiology, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
چکیده [English]

Background: Kidney transplantation is the preferred treatment for most patients with end-stage renal disease (ESRD) and therefore, kidney transplantation survival analysis is important. The aim of this study was to determine the cumulative survival rate of renal transplantation and the factors affecting it.Methods: This was a historic cohort study including information of 381 patients with end-stage renal disease who underwent kidney transplantation surgery from December 2007 to March 2016 in Noor hospital, Isfahan, Iran. The Kaplan-Meier method, Log Rank test and Cox regression model were used for statistical analysis. Data analysis was carried out with R software, Version 3.1.0, at the significance level of P < 0.05.Findings: According to Kaplan-Mayer method, 1-, 3-, 5- and 8-year survival rates of transplanted kidney were estimated as 98.7, 93.3, 86.9, and 83.9 percent, respectively. The results of Cox regression model indicated that the time duration of dialysis before transplantation (P < 0.05), and the level of creatinine at the time of discharge from hospital (P < 0.05) had significant relationship with survival of transplanted kidney.Conclusion: The survival rate of the transplanted kidney calculated for this center was suitable in comparison with other transplant centers. The level of creatinine at the time of discharge from hospital and the time duration of dialysis prior to transplantation were the factors influencing survival of the graft.

کلیدواژه‌ها [English]

  • Kidney transplantation
  • Transplantation
  • Survival
  • End-stage renal disease
  • Regression Analysis

مراجع

  1. Wiener C, Fauci AS, Braunwald E, Kasper DL, Hauser S, Longo D. Harrisons principles of internal medicine self-assessment and board review. 18th ed. New York, NY: McGraw-Hill Education; 2012.
  2. Afshar R, Sanavi S, Salimi J. Epidemiology of chronic renal failure in Iran: a four year single- center experience. Saudi J Kidney Dis Transpl 2007; 18(2): 191-4.
  3. Makhdoumi K, Yekta Z, Ahmadpoor P, Ghaffari Moghaddam A, Sadeghi N, Ghaderi P, et al. One year graft survival: A comparison the effect of AZA (azathioprine) and Mycophenolat Mofetil (MMF). J Urmia Univ Med Sci 2007; 18(2): 474-9. [In Persian].
  4. Wong G, Howard K, Chapman JR, Chadban S, Cross N, Tong A, et al. Comparative survival and economic benefits of deceased donor kidney transplantation and dialysis in people with varying ages and co-morbidities. PLoS One 2012; 7(1): e29591.
  5. Salehipour M, Salahi H, Jalaeian H, Bahador A, Nikeghbalian S, Barzideh E, et al. Vascular complications following 1500 consecutive living and cadaveric donor renal transplantations: a single center study. Saudi J Kidney Dis Transpl 2009; 20(4): 570-2.
  6. Einollahi B, Pourfarziani V, Ahmadzad-Asl M, Davoudi F, Lessan-Pezeshki M, Davoudi A, et al. Iranian model of renal allograft transplantation in 3028 recipients: Survival and risk factors. Transplant Proc 2007; 39(4): 907-10.
  7. Etemad Newspaper. There is no statistical indication of the number of kidney patients in Iran (No. 2347) [Online]. [cited 2012 Mar 3]. Available from: URL: http://www.magiran.com/npview.asp?ID=2462706
  8. Almasi Hashiani A, Rajaeefard A, Hassanzade J, Salahi H. Survival analysis of renal transplantation and its relationship with age and sex. Koomesh 2010; 11(4): 302-6. [In Persian].
  9. Javanrouh Givi N, Alimi R, Esmaily H, Shakeri M, Shamsa A. Assessment of effective factors on renal transplantation survival and estimation of rejection hazard for transplanted in Mashhad Qaem hospital. J North Khorasan Univ Med Sci 2013; 5(2): 315-21. [In Persian].
  10. Abdi E, Savaj S, Nejadgashti H, Aris S, Prooshani Nia F, Ataipour Y, et al. Renal transplantation results in Hashemi Nejad hospital during 1996-2005 and its Comparison with that of 1986-1996. Razi J Med Sci 2006; 13(50): 113-20. [In Persian].
  11. Ghanei E, Nasrolahi A, Razaghi M. Evaluation short and long term graft and survival rates in kidney transplanted patients between 1995-2011. Ann Mil Health Sci Res 2012; 9(4): 251-5. [In Persian].
  12. Briganti EM, Wolfe R, Russ GR, Eris JM, Walker RG, McNeil JJ. Graft loss following renal transplantation in Australia: Is there a centre effect? Nephrol Dial Transplant 2002; 17(6): 1099-104.
  13. Orsenigo E, Socci C, Carlucci M, Zuber V, Fiorina P, Gavazzi F, et al. Multivariate analysis of factors affecting patient and graft survival after renal transplant. Transplant Proc 2005; 37(6): 2461-3.
  14. Pallet N, Thervet E, Alberti C, Emal-Aglae V, Bedrossian J, Martinez F, et al. Kidney transplant in black recipients: are African Europeans different from African Americans? Am J Transplant 2005; 5(11): 2682-7.
  15. Suzuki T, Nakao T, Harada S, Nakamura T, Koshino K, Sakai K, et al. Results of kidney transplantation for diabetic nephropathy: a single-center experience. Transplant Proc 2014; 46(2): 464-6.
  16. Maamoun HA, Soliman AR, Fathy A, Elkhatib M, Shaheen N. Diabetes mellitus as predictor of patient and graft survival after kidney transplantation. Transplant Proc 2013; 45(9): 3245-8.
  17. Hanzadeh J, Salahi H, Rajaeifar AR, Zeighami B, Almasi A. 10-year Graft survival analysis of renal transplantation and factors affecting it in patients transplanted from live donor in Shiraz Transplant Research Center during 1999-2009. J Kerman Univ Med Sci 2010; 17(1): 28-39. [In Persian].
  18. Feyssa E, Jones-Burton C, Ellison G, Philosophe B, Howell C. Racial/ethnic disparity in kidney transplantation outcomes: influence of donor and recipient characteristics. J Natl Med Assoc 2009; 101(2): 111-5.
  19. Courtney AE, McNamee PT, Maxwell AP. The evolution of renal transplantation in clinical practice: for better, for worse? QJM 2008; 101(12): 967-78.
  20. Almasi Hashiani A, Rajaee Fard A, Hassanzaede J, Salahi HO. Graft survival rate of renal transplantation in diabetic patients, Namazi Hospital Transplant Center, Shiraz, Iran (1999-2009).Iran J Endocrinol Metab 2010; 12(4): 385-92. [In Persian].
  21. Tang H, Chelamcharla M, Baird BC, Shihab FS, Koford JK, Goldfarb-Rumyantzev AS. Factors affecting kidney-transplant outcome in recipients with lupus nephritis. Clin Transplant 2008; 22(3): 263-72.
  22. Hashemian AH, Beiranvand B, Rezaei M, Roshani-Sheykhabad A, Bardideh A. Five-year survival analysis of renal transplantation graft and affecting factors. J Isfahan Med Sch 2014; 32(283): 550-7. [In Persian].
  23. Rocha A, Malheiro J, Martins LS, Fonseca I, Dias L, Pedroso S, et al. Kidney transplantation in type 2 diabetic patients: A matched survival analysis. Transplant Proc 2013; 45(6): 2141-6.
  24. Ansari S, Azarkivan A, Salahmand M, Lotfi P. Assessment of alloimmunization in multi transfuse (thalassemia) patients admitted in Ali Asghar Children's Hospital during 2004-05. Razi J Med Sci 2009; 16(62): 65-72. [In Persian].
  25. Oriol R, Le PJ, Chun C. Influence of the original disease, race, and center on the outcome of kidney transplantation. Transplantation 1982; 33(1): 22-6.
  26. Vergoulas G, Ioannidis I, Nikodimopoulou M, Miserlis G, Solonaki F, Panou E, et al. Outcomes of kidney transplantation in Greek and Albanian patients: A single centre experience. Hippokratia 2008; 12(3): 176-80.
  27. Remuzzi G, Cravedi P, Costantini M, Lesti M, Ganeva M, Gherardi G, et al. Mycophenolate mofetil versus azathioprine for prevention of chronic allograft dysfunction in renal transplantation: The MYSS follow-up randomized, controlled clinical trial. J Am Soc Nephrol 2007; 18(6): 1973-85.
  28. Shapiro R, Jordan ML, Scantlebury VP, Vivas C, Gritsch HA, Fox-Hawranko L, et al. Reducing the length of stay after kidney transplantation--the intensive outpatient unit. Clin Transplant 1998; 12(5): 482-5.
  29. Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 2001; 344(10): 726-31.
  30. Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation 2002; 74(10): 1377-81.
  31. Hashemian A, Beiranvand B, Rezaei M, Reissi D. A comparison between cox regression and parametric methods in analyzing kidney transplant survival. World App Sci J 2013; 26(4): 502-7.
مجله دانشکده پزشکی اصفهان
دوره 35، شماره 442 - شماره پیاپی 442
مهر و آبان 1396
صفحه 1022-1029

فایل ها

سابقه مقاله

  • تاریخ دریافت: 07 مرداد 1396
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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