Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: a South African perspective
Method:
Data were collected on all patients who underwent a kidney transplant at GSH from 1st July 2010 to the 30 June 2015. Analyses were performed to assess baseline characteristics, graft and patient survival, as well as predictors of poor outcome.
Results
198 patients
were transplanted. The mean age was 38 +/- 10.5 years, 127 (64.1%) were male, and 86 (43.4%) were of African
ethnicity. Deceased donor organs were used for 130 (66.7%) patients and living
donors for 65 (33.3%). There were > 5 HLA mismatches in 58.9% of transplants.
Sepsis was the commonest cause of death and delayed graft function [DGF]
occurred in 41 (21.4%) recipients. Patient
survival was 90.4% at 1 year and 83.1% at 5 years. Graft survival was 89.4% at
1 year and 80.0% at 5 years. DGF (HR 2.83 (1.12 – 7.19), p value = 0.028) and
recipient age > 40 years (HR 3.12 (1.26 – 7.77), p value = 0.014) were predictors
of death.
Ethics Statement:
Ethical approval for the study was received from the human research ethics committee at University of Cape Town [HREC: 759/2014]. This approval permitted a folder review of patients transplanted within the specified time period. Informed consent for folder review was waived. All clinical and laboratory data was obtained from routine clinic visits (set out by KDIGO best clinical practice guidelines). All kidney biopsies were only performed for clinical indications including unexplained haematuria, proteinuria or rising creatinine.
For confidentiality and anonymity all patients were anonymised prior to statistical analysis. The information was stored on a password protected research computer, only the primary and sub investigators had access to the data.
None of the transplant donors were from a vulnerable population and all donors or next of kin provided written informed consent that was freely given. The consent for deceased donation was obtained by dedicated transplant sisters who work as part of the transplant team. All Living non-related donors are ethically evaluated by a national Ministry Advisory Committee. Groote Schuur Hospital transplant department complies with the Declaration of Istanbul.
