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

Objectives To determine the long-term survival rates and prognostic
factors in kidney transplant (KT) recipients in Jakarta, Indonesia. Design
Retrospective cohort study. Setting A KT centre in Jakarta. Participants
We enrolled 754 consecutive adult recipients who underwent KT between 2010
and 2020. Main outcome measures Rates of 10-year patient, all-cause and
death-censored graft survival and their prognostic factors in KT
recipients. Results The 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).
Conclusions The 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.