Evolution of the renal graft function and the phosphocalcic metabolism after deceased donor kidney transplantation vs living donor kidney transplantation

Abstract

There are two types of donors for the transplantation in patients with end-stage kidney failure, deceased kidney donors (DD) and living kidney donors (LD). It has been shown that kidney transplantation (KT) from LD offers better graft survival than DD.

The objective was to analyze the graft renal function and the phosphocalcic metabolism in KT recipients from DD and LD in different stages of the KT (pre, post immediate, at 6 months and one year from KT).

A retrospective study from KT clinical histories (2008 to 2017 period) of the Vélez Sarsfield Clinic Nephrology Service were studied. Calcemia, phosphatemia, alkaline phosphatase (AP), urea, creatinine and albumin were analyzed. Age, sex, dialysis time, cold ischemia time (TIC) were registered. The T-Student test was used for statistical analysis.

A total of 79 transplants were included: 53 from DD and 26 from LD. The age of patients (years), the dialysis time (months) and the TIC (minutes) were lower in LD vs DD recipients (46.4 ± 14.1 vs. 53.6 ± 12.3, p < 0.05; 27.6 ± 19.8 vs. 82 ± 42, p <0.001; 1085 ± 345 vs 94 ± 41, p <0.001, respectively). Phosphorus and creatinine levels pre-KT were higher in DD kidney transplant recipients (5.7 ± 1.7 vs. 4.9 ± 1.8, p <0.05; 8.5 ± 2.4 vs 7.1 ± 3.4, p <0.05, respectively); these results were keeping after KT. At 6 months post-KT all parameters analyzed did not show differences between both groups. At 12 months post TR the AP was highest in the group that received the DD kidney trasplant (241 ± 109 vs. 201 ± 59, p <0.05). These results indicate alterations in bone dynamics of transplanted patients because of length of time on pre-KT dialysis.

We conclude that LD kidney transplant recipients present better condition than the DD kidney transplant recipients with respect phosphocalcic metabolism. The most relevant factors to explain these results could be the lower age of the recipient, the lower TIC and time on dialysis.

Keywords:  renal transplant, phosphocalcic metabolism, renal function, living donor, deceased donor.