REAL LIFE SINGLE-CENTRE EXPERIENCE IN PATIENTS WITH LONG-SURVIVAL RENAL TRANSPLANTATION

Background and Aims Kidney transplantation is the gold standard treatment for ESRD. Although the short-term results of kidney transplantation have improved significantly in the last 20 years, the increase in survival rates and the improvement of long-term graft outcomes represent a main challenge. Therefore, clinical data on patients with a long history of kidney transplantation are lacking and open field of research. The target of the study is to describe the outcomes in terms of renal function, immunological, infectious and neoplastic complications, and immunosuppressive therapy schemes, in a peculiar population of patients with long-lasting renal transplants. Method This is a retrospective, monocentric and observational cohort study. The study population consists of patients that underwent kidney transplantation in a single Kidney Transplant Unit from 1978 to 2012 and still in follow-up within the same Unit with a functioning graft. Data were extracted from the Hospital digital medical records after informed consent has been obtained. We analysed renal function at 5-year intervals from discharge to the last evaluation using eGFR calculated with the CKD-EPI formula. Data on demographic characteristics, comorbidities, immunosuppressive therapies and complication (divided as infectious, immunological and malignancy) has also been evaluated. Results We enrolled 332 patients with a mean follow-up of 17.9± 6.5 years, of whom 101 (30.4%) with a follow-up >20 years. Figure 1 shows the trend of renal function during the follow-up years. In Table 1 are reported the comorbidities and immunological, infectious and neoplastic complications. 46 (14.5 %) patients underwent a “for cause” kidney biopsy. The main finding, with 62% was transplant glomerulopathy/interstitial fibrosis and tubular atrophy (TG/IFTA) with a mean post-transplant onset of 12.8 years (± 6.1), 9% of rejection findings with a mean time to onset of chronic rejection of 18 years (±8) and 1.3% of biopsied patients received a diagnosis of recurrence with a mean onset of 10.8 years (±4.4). 36.1% of the patients experienced at least one neoplasm with an average post-transplant onset time of 13.4 (±7.7). Infectious complications occurred in 36.1% of the transplanted patients. Conclusion This study provides an exhaustive overview of the characteristics and clinical complications in a “real life” experience with long survivor kidney transplants with the aim to better understand the needs and problems of this peculiar population in order to guide clinician in a more targeted management.