Sixteen years of kidney transplant: an open cohort in brazil’s Unified Health System

Resumo

Objective: To analyze the graft survival of kidney transplant patients in Brazil between
2000 and 2015. Methods: Open historical cohort of kidney transplant patients through
the SUS, constructed through deterministic-probabilistic matching of administrative da
tabases. The cumulative probability of survival was estimated using Kaplan-Meier and
the difference between the curves compared using the Log-Rank Test. Potential factors
associated with graft loss were evaluated by univariate and multivariate analyses. The
Cox model was used to calculate the Hazard-Ratio considering the 95% confidence in
terval. Results: 44,795 patients were included. The majority were male (60.1%) with a
median age of 42 years. The analysis demonstrated renal graft survival rates of 91.2%,
77.0%, 57.5% and 42.1% for one, five, ten and 15 years respectively. Multivariate
analysis demonstrated that a higher risk of graft loss was associated with transplantation
with deceased donor organs, additional years of age, patients who declared themselves
black, longer median period of dialysis prior to transplantation (>38 months), diagnosis
primary treatment of diabetes mellitus and arterial hypertension and immunosuppressive
regimen containing mycophenolate. Conclusion: This nationwide retrospective analysis
presents epidemiological data of relevance to public health regarding the survival rate
and risk factors associated with graft loss in kidney transplant patients in the SUS. The
results provide of the scenery of kidney transplantation in the country, demonstrating
efficiency and progressive improvements that are potentially useful for managers in ree
valuating clinical guidelines.