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Research Article
Michael D Hughson
University of Sulaymaniyah
Corresponding Author
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Background
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.
Methods
In 2019, in Iraqi Kurdistan, 301 of 871 renal transplant patients had indicated graft biopsies. Outcomes were followed over the subsequent year of 2020.
Results
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).
Conclusions
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.
Keywords
kidney transplantation, kidney allograft pathology, allograft rejection, acute and chronic allograft failure
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No competing interests reported.
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Received 18 Mar, 2021
Reviewer #2 agreed
On 02 Mar, 2021
Reviewer #5 agreed
On 02 Mar, 2021
Reviewer #7 agreed
On 02 Mar, 2021
Reviewer #3 agreed
On 02 Mar, 2021
Reviewer #1 agreed
On 02 Mar, 2021
Reviewer #6 agreed
On 02 Mar, 2021
Reviewer #4 agreed
On 02 Mar, 2021
Reviewer #8 agreed
On 02 Mar, 2021
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Invitations sent on 02 Mar, 2021
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Editor invited
On 02 Mar, 2021
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Subject Areas
Urology & Nephrology
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This preprint is under consideration at BMC Nephrology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Michael D Hughson
University of Sulaymaniyah
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 03 Mar, 2021
No community comments so far
Editorial decision: Major revision
On 07 Apr, 2021
Review #1 received
Received 18 Mar, 2021
Review #3 received
Received 18 Mar, 2021
Review #2 received
Received 18 Mar, 2021
Review #4 received
Received 18 Mar, 2021
Reviewer #2 agreed
On 02 Mar, 2021
Reviewer #5 agreed
On 02 Mar, 2021
Reviewer #7 agreed
On 02 Mar, 2021
Reviewer #3 agreed
On 02 Mar, 2021
Reviewer #1 agreed
On 02 Mar, 2021
Reviewer #6 agreed
On 02 Mar, 2021
Reviewer #4 agreed
On 02 Mar, 2021
Reviewer #8 agreed
On 02 Mar, 2021
Reviewers invited
Invitations sent on 02 Mar, 2021
Editor assigned
On 02 Mar, 2021
Editor invited
On 02 Mar, 2021
Submission checks complete
On 02 Mar, 2021
First submitted
On 11 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
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.
Methods
In 2019, in Iraqi Kurdistan, 301 of 871 renal transplant patients had indicated graft biopsies. Outcomes were followed over the subsequent year of 2020.
Results
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).
Conclusions
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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