Kronik Allograft Fonksiyon Bozukluğu Risk Faktörleri ve Nedenleri

Abstract

Chronic kidney disease; is an important health issue both by increasing morbidity and mortality and its high burden on country economics. Dialysis or renal transplantation are the two treatment options for end stage renal disease patients. Renal transplantation from an appropriate donor; when compared with dialysis, improves quality of life and reduces morbidity and mortality. Renal transplantation rates have been increasing for the last 30 years. Following transplantation graft survival is the primary goal. Despite reaching over 90 % success rates in 1-year graft survival as a result of improvements in immunosuppressive therapy, similar success rates have not been achieved in long term graft survival rates. Chronic allograft dysfunction, has become the most important cause of graft loss in chronic period becoming the focus of interest of renal transplant specialists. 80 patients, followed up by Nephrology Department of Hacettepe University School of Medicine, on whom renal biopsy was performed due to chronic allograft dysfunction are included in this study. Etiologies of chronic allograft dysfunction were evaluated according to pathologic results of renal biopsy specimens and laboratory findings. Possible immunological and non-immunological risk factors of graft dysfunction were screened and recorded retrospectively. Panel Reactive Antibody (PRA) and donor specific anti-HLA antibodies (DSA) positivity, late graft dysfunction, longer periods of waiting time on dialysis, longer periods of cold ischemia, increased numbers of Human Leucocyte Antigen (HLA) mismatch pretransplantation were independent risk factors for chronic allograft dysfunction. Causes of chronic allograft dysfunction were detected to be; cellular and humoral rejection, calcineurin inhibitor toxicity, recurrent or de novo glomerulonephritis, tubulointerstitial nephritis and polyoma virus nephropathy.