Curso clínico de uma coorte de pacientes pediátricos submetidos ao transplante renal: uma análise de sobrevida

• Ano de defesa: 2012
• Autor(a) principal: Mariana Guerra Duarte
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Sobrevida do enxerto; Fatores de risco; Transplante renal pediátrico; Rins Transplante; Transplante de rim; Função retardada de enxerto; Sobrevivência de enxerto; Pediatria
• Link de acesso: http://hdl.handle.net/1843/BUOS-9USML4

z Renal transplantation is the treatment of choice for children with end-stage renal disease (ESRD). In this study, we retrospectively analyzed data of 64 pediatric patients undergoing 66 kidney transplants between 2000 and 2011, at Hospital das Clínicas UFMG. The mean age at transplantation was 10,5±3,9 years (2,6-16,7 yrs). The most common etiology of ESRD was hereditary nephrouropathies (32,8%) and the etiology was unknown in 10,8%. Six patients (9,1%) were transplanted preemptively and the mean duration of dialysis before transplantation was 36,5±25,5 months (2-116 months). Of all transplants, 57,6% were from deceased donors and mean cold ischemia time was 22,2±6,3 hours (13-41 hrs). Delayed graft function occured in 22,7% of the transplants (15/66). We identified an improvement of weight, height and body mass índex within the first year after transplantation (p<0,05) and only of height from the first to the fifth year (p=0,007). Hypertension was diagnosed in 65,6% of patients with good control with the use of antihypertensive drugs in 93,1%. The mean values of creatinine increased significantly between the first, fifth and tenth year (p<0,05). The estimated GFR showed no statistical difference between the first and fifth years, but significant reduction was observed in the tenth year after transplantation. Twelve patients lost their grafts (19,7%). The estimated median graft survival was 9,2 years and graft survivals at 1,5 and 10 years were 91,7%, 81,2% and 75,6%, respectively. Overall 1, 5 and 10 years patient survival was 98,3%, 95,8% and 92,8%. We found no statistically significant difference in graft survival in relation to the type of donor - live vs deceased (p=0,56), to the age of the recipient (p=0,48), to the presence of hypertension (p=0,63), to the presence of more than three HLA mismatches (p=0,89) and to preemptive vs post- dialysis transplant (0,97). Poorer graft survival was observed with cold ischemia time exceeding 24 hours (p=0,042), delayed graft function (p=0,028), early and late acute rejection (p=0,05 and p=0,046) and serum creatinine greater than 1mg/dl at the end of first year of transplantation (p<0,001). We also found as variables associated with progression to CKD stage 3 the presence of acute rejection, the need for post-transplant dialysis and cold ischemia time superior to 24 hours. We conclude that graft and patients survival were similarto that published in the literature although there is a need for the transplant team to make an extra effort in order to reduce cold ischemia time, minimizing delayed graft function, actions that can improve graft survival.