Evaluation of the 1000 renal transplants carried out at the University Hospital of the Botucatu Medical School (HCFMB) - UNESP and their evolution over the years

ABSTRACT Introduction: The progress in kidney transplantation has been evident over the years, as well as its benefits for patients. Objectives: To evaluate the 1.000 kidney transplants performed at the Botucatu Medical School University Hospital, subdividing the patients in different periods, according to the current immunosuppression, and evaluating the differences in graft and patient survival. Methods: Retrospective cohort analysis of the transplants performed between 06/17/87 to 07/31/16, totaling 1,046 transplants, subdivided into four different periods: 1) 1987 to 2000: cyclosporine with azathioprine; 2) 2001 to 2006: cyclosporine with mycophenolate; 3) 2007 to 2014: tacrolimus with antimetabolic; and 4) 2015 to 2016: tacrolimus with antimetabolic, with increased use of the combination of tacrolimus and mTOR inhibitors. Results: There was an increase in the mean age of recipients and increase in deceased donors and their age in the last two periods. There was a reduction in graft function delay, being 54.3% in the fourth period, compared to 78.8% in the first, p = 0.002. We found a reduction in acute rejection, being 6.1% in the last period compared to 36.3% in the first, p = 0.001. Urological complications and diabetes after transplantation were more frequent in the first two periods. The rates of cytomegalovirus infection were higher in the last two periods. There was an improvement in graft survival, p = 0.003. There was no difference in patient survival, p = 0.77 (Figure 2). Conclusion: There was a significant increase in the number of transplants, with evolution in graft survival, despite the worsening in the profiles of recipients and donors.

摘要
引言：多年来，肾脏移植技术发展迅猛，其为患者带来的临床获益亦愈发显著。
研究目的：本研究旨在评估博图卡图医学院附属医院完成的肾脏移植手术，最初拟纳入1000例，实际共计1046例；依据当前临床常用的免疫抑制治疗方案将患者划分为不同阶段，分析移植物与患者生存率的差异。
研究方法：本研究采用回顾性队列分析方法，纳入1987年6月17日至2016年7月31日期间开展的肾脏移植手术，并将其分为四个阶段：①1987年—2000年：环孢素（cyclosporine）联合硫唑嘌呤（azathioprine）方案；②2001年—2006年：环孢素联合麦考酚酯（mycophenolate）方案；③2007年—2014年：他克莫司（tacrolimus）联合抗代谢药物（antimetabolic）方案；④2015年—2016年：他克莫司联合抗代谢药物方案，且他克莫司与mTOR抑制剂联合应用的比例有所提升。
研究结果：近两个阶段的受者平均年龄升高，尸体供者的数量及供者平均年龄亦呈上升趋势。移植物功能延迟恢复发生率呈下降趋势：第四阶段该发生率为54.3%，第一阶段为78.8%，p=0.002。急性排斥反应发生率显著降低：最后一阶段该发生率为6.1%，第一阶段为36.3%，p=0.001。前两个阶段的泌尿系统并发症与移植后糖尿病发生率更高。巨细胞病毒感染率在近两个阶段更高。移植物生存率得到明显改善，p=0.003；而患者生存率无显著差异，p=0.77（图2）。
结论：尽管受者与供者的临床基线特征趋于复杂，但肾脏移植手术量已实现显著增长，移植物生存率亦得到优化提升。