In the developing world, transplantation is the most common long-term treatment for patients with end-stage renal disease, but rates and causes of graft failure are uncertain.
In 2019, in Iraqi Kurdistan, 301 of 871 renal transplant patients had indicated graft biopsies. Outcomes were followed over the subsequent year of 2020.
The post-transplantation time ranged from one day to 18 years. All donors were living. Approximately 15% of transplants were preemptive. Pretransplant hemodialysis (HD) was twice weekly and less than one year. The median recipient age was 39 (IQR 28 to 48) years. 5.5% of recipients had previous transplants; 3.7% had pretransplant donor-specific antibodies (DSA). The Kaplan-Meier estimated graft failure rates for all-cause, return to HD, and death with functional graft (DWFG) were 9.1%, 6.3%, and 2.9% at one year and 23.8%, 6.3%, and 7.4% at five years. The median death-censored graft survival was 15 years. The most frequent biopsy diagnoses associated with graft failure were interstitial fibrosis and tubular atrophy (IF/TA) (23.1%), transplant glomerulopathy (13.7%), and acquired active antibody-mediated rejection (11.1%). The significant predictors of graft loss were C4d + biopsies (P < 0.01) and advanced IF/TA (P < 0.001).
These Iraqi patients had estimated graft failure rates similar to the United States (US) Renal Data System living-donor outcomes reported for the year 2000. The inability to approach recent US graft survivals may owe to inadequate pretransplant dialysis. Nevertheless, prolonged survival made chronic disorders and acquired DSA the leading causes of graft failure and is creating a need for second transplants.
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No competing interests reported.
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Posted 03 Mar, 2021
On 07 Apr, 2021
Received 18 Mar, 2021
Received 18 Mar, 2021
Received 18 Mar, 2021
Received 18 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
Invitations sent on 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 11 Feb, 2021
Posted 03 Mar, 2021
On 07 Apr, 2021
Received 18 Mar, 2021
Received 18 Mar, 2021
Received 18 Mar, 2021
Received 18 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
Invitations sent on 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 02 Mar, 2021
On 11 Feb, 2021
In the developing world, transplantation is the most common long-term treatment for patients with end-stage renal disease, but rates and causes of graft failure are uncertain.
In 2019, in Iraqi Kurdistan, 301 of 871 renal transplant patients had indicated graft biopsies. Outcomes were followed over the subsequent year of 2020.
The post-transplantation time ranged from one day to 18 years. All donors were living. Approximately 15% of transplants were preemptive. Pretransplant hemodialysis (HD) was twice weekly and less than one year. The median recipient age was 39 (IQR 28 to 48) years. 5.5% of recipients had previous transplants; 3.7% had pretransplant donor-specific antibodies (DSA). The Kaplan-Meier estimated graft failure rates for all-cause, return to HD, and death with functional graft (DWFG) were 9.1%, 6.3%, and 2.9% at one year and 23.8%, 6.3%, and 7.4% at five years. The median death-censored graft survival was 15 years. The most frequent biopsy diagnoses associated with graft failure were interstitial fibrosis and tubular atrophy (IF/TA) (23.1%), transplant glomerulopathy (13.7%), and acquired active antibody-mediated rejection (11.1%). The significant predictors of graft loss were C4d + biopsies (P < 0.01) and advanced IF/TA (P < 0.001).
These Iraqi patients had estimated graft failure rates similar to the United States (US) Renal Data System living-donor outcomes reported for the year 2000. The inability to approach recent US graft survivals may owe to inadequate pretransplant dialysis. Nevertheless, prolonged survival made chronic disorders and acquired DSA the leading causes of graft failure and is creating a need for second transplants.
Figure 1
Figure 2
Figure 3
Figure 4
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