Factors of renal insufficiency after renal transplantation were analyzed to provide a better methods for the long-term survival of the graft.

Clinical data of 592 renal transplantation recipients in West China Hospital of Sichuan University from January 2013 to December 2015 were retrospectively analyzed, including gender of the donor, serum creatinine level and estimated glomerular filtration rate(eGFR); recipients age, gender, ethnicity, body mass index (BMI), HBsAg, serum creatinine level and Tacrolimus-intra patient variant (Tac-IPV); donor kidney type, HLA mismatch number. According to the survival of renal allografts, the recipients were divided into renal insufficiency group and stable renal allograft group. The recipients were divided into high variation group (Tac-IPV≥32.1) and low variation group (Tac-IPV<32.1) on the basis of the median of Tac-IPV. According to the Chinese Adult Overweight and Obesity Prevention and Control Guidelines, the recipients were divided into low BMI group (<18.5 kg/m²), normal BMI group (18.5-<24 kg/m²) and high BMI group (≥24 kg/m²). The t-test or U test was used to compare the donor′s pre-donation serum creatinine level, eGFR and the recipient′s age, BMI, serum creatinine level and Tac-IPV. Variables with P<0.10 in univariate analysis were included in multivariate Logistic regression analysis. Kidney allograft survival curves were plotted using the Kaplan-Meier method and compared using the Logrank test. Cox proportional hazards model was used to analyze the risk factors affecting renal allograft survival. Chi-square test was used to compare the donor′s gender and the recipient′s gender, ethnicity, HBsAg, donor kidney type, and number of HLA mismatches. P<0.05 was considered statistically significant.

The average age of 592 renal transplantation recipients was (33±9) years (18-60 years), including 452 males and 140 females. There were 519 cases of Han nationality and 73 cases of ethnic minorities. 533 patients in the stable group and 59 patients in the insufficiency group were included, respectively. As of August 2017, the average follow-up time of the recipients was (30±11) months (1-54 months). The difference of gender, ethnicity, BMI and TC-IPV of recipients between the renal insufficiency group and stable renal allograft group were statistically significant (χ²/U=5.040, 3.677, 6.710 and 30.152, P all<0.05). Logistic regression multivariate analysis showed that gender, ethnicity, BMI and Tac-IPV of recipients were independent risk factors for renal graft dysfunction (OR=0.308, 1.101, 2.246 and 137.369, P all<0.05). The survival rate of transplanted kidney in female recipients was higher than that in male recipients, and the survival rate of transplanted kidney in the high-variation Tac-IPV group was lower than that in the low-variation Tac-IPV group, the differences were statistically significant (χ²=5.88 and 27.04, P all<0.05). The survival rate of transplanted kidney in the high BMI group was the lowest, and the survival rate of transplanted kidney in the low BMI group was lower than that in the normal group, the difference was statistically significant (χ²=8.071, P<0.05). Cox proportional risk model analysis showed that the risk factors affecting the survival of kidney transplantation were recipients gender, ethnicity, BMI and Tac-IPV (HR=2.934, 0.506, 51.291 and 1.077, P all<0.05).

Early detection and intervention of BMI and Tac-IPV can help to maintain the long-term survival of renal allografts and improve the prognosis of recipients.