Original Article

Factors Affecting the Long-Term Survival of Kidney Transplanta-tion in Northeastern of Iran between 2000 and 2015


Background: Graft and patient survival are of great importance after transplantation. This study aimed to determine the long-term survival rate of kidney transplantation and its effective factors among transplanted patients in Mashhad transplantation centers in northeastern Iran.

Methods: Overall, 618 kidney transplant recipients were examined in different transplantation centers during the years from 2000 to 2015 in a historical cohort study. The Kaplan-Meier method and the Log-rank test were used to calculate the survival rate of the kidney transplant, and to check the difference between survival curves respectively. Modeling of effective factors in survival rate was performed using Cox regression model.

Results: Overall, 1, 3, 5, 7, 10, and 15-year survival rate of kidney transplantation were 99%, 98%, 97%, 93%, 88 and 70% respectively. The adjusted hazard ratio indicated that variables such as recipient age >40 yr [HR=0.22, 95% CI=(0.071,0.691)], serum creatinine after transplantation >1.6 Mg/dl [HR=3.03, 95% CI=(1.284,7.125)], history of hypertension [HR=6.70, 95% CI=(2.746,16.348)], and BMI [HR (normal weight versus underweight)=0.26, 95% CI=(0.088,0.761), HR (over weight versus underweight)=0.13,95% CI=(0.038,0.442)] were significant factors on kidney transplant survival rate.

Conclusion: The short-term transplant survival rate was good in transplant patients. What's more, through a consideration of variables such as age, creatinine serum after transplantation, history hypertension and body mass index, as well as proper planning to control their effect, it is possible to improve the long-term graft survival rate.

1. Aghighi M, Mahdavi-Mazdeh M, Zamyadi M, et al (2009). Changing epidemiology of end-stage renal disease in last 10 years in Iran. Iran J Kidney Dis, 3(4):192-6.
2. Auglienė R, Dalinkevičienė E, Kuzminskis V, et al (2017). Factors influencing renal graft survival: 7-Year experience of a single center. Medicina (Kaunas), 53(4):224-232.
3. Khajehdehi P, Malekmakan L, Pakfetrat M, et al (2014). Prevalence of chronic kidney disease and its contributing risk factors in southern Iran: a crosssectional adult population-based study. Iran J Kidney Dis, 8(2):109-15.
4. Nafar M, Mousavi SM, Mahdavi-Mazdeh M, et al (2008). Burden of chronic kidney disease in Iran: a screening program is of essential need. Iran J Kidney Dis, 2(4):183-92.
5. Hage FG, Smalheiser S, Zoghbi GJ, et al (2007). Predictors of survival in patients with endstage renal disease evaluated for kidney transplantation. Am J Cardiol, 100(6):1020-5.
6. Hassanien AA, Al-Shaikh F, Vamos EP, et al (2012). Epidemiology of end-stage renal disease in the countries of the Gulf Cooperation Council: a systematic review. JRSM Short Rep, 3(6):38.
7. Weber M, Faravardeh A, Jackson S, et al (2014). Quality of life in elderly kidney transplant recipients. J Am Geriatr Soc, 62(10):1877-82.
8. Go AS, Chertow GM, Fan D, et al (2004). Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med, 351(13):1296-305.
9. Pascual M, Theruvath TOM, Kawai T, et al (2002). Strategies to improve long -term outcomes after renal transplantation. N Engl J Med, 346(26):2089-92.
10. Woodroffe R, Yao GL, Meads C, et al (2005). Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study. Health Technol Assess, 9(21):1-179.
11. Irish WD, Ilsley JN, Schnitzler MA, et al (2010). A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation. Am J Transplant, 10(10):2279-86.
12. Wang W, Li XB, Yin H, et al (2011). Factors affecting the long-term renal allograft survival. Chin Med J (Engl), 124(8):1181-4.
13. Mousavi SSB, Soleimani A, Mousavi MB (2014). Epidemiology of End-Stage Renal Disease in Iran : A Review Article. Saudi J Kidney Dis Transplant, 25(3):697-702.
14. Ghanei E, Nasrolahi A, Razaghi M (2011). Evaluation Short and Long term Graft and survival rates in kidney transplanted patients between 1995-2011. J Army Univ Med Sci., 9:251-55.
15. Hashiani AA, Rajaeefard A, Hassanzade J, et al (2006). Survival analysis of renal transplantation and its relationship with age and sex. koomesh, 11(4):302-306.
16. Hassanzadeh J, Hashiani AA, Rajaeefard A, et al (2010). Long-term survival of living donor renal transplants: A single center study. Indian J Nephrol, 20(4):179-84.
17. Saatchi M, Poorolajal J, Amirzargar MA, et al (2013). Long-term survival rate of kidney graft and associated prognostic factors : A retrospective cohort study. Ann Transplant, 18:153-60.
18. Einollahi B, Pourfarziani V, Davoudi F, et al (2007). Iranian Model of Renal Allograft Transplantation In 3028 Recipients : Survival and Risk Factors. Transplant Proc, 39(4):907-10.
19. Mirzaee M, Azmandian J, Zeraati H, et al (2014). Short-term and Long-term Survival of Kidney Allograft Cure Model Analysis. Iran J Kidney Dis, 8(3):225-30.
20. Soltanian A, Mahjub H, Taghizadeeh-afshari A, et al (2015). Identify Survival Predictors of the First Kidney Transplantation : A Retrospective Cohort Study. Iran J Public Health, 44(5): 683–689.
21. World Health Organization. Global Database on Body Mass Index.; Available from:
a. http://www.assessmentpsychology.com/icbmi.htm
22. Kwon OJ, Kwak JY (2004). The Impact of Sex and Age Matching for Long-Term Graft Survival in Living Donor Renal Transplantation. Transplant Proc, 36(7):2040-2.
23. Pita-Fernandez S, Valdes-Canedo F, Seoane-Pillado T, et al (2010). Influence of early graft function after renal transplantation and its impact on long-term graft and patient survival. Transplant Proc, 42(8):2856-8.
24. Cho H, Yu H, Shin E, et al (2014). Risk Factors for Graft Failure and Death following Geriatric Renal Transplantation. PLoS ONE, 11(4): e0153410.
25. Collins AJ, Foley RN, Chavers B, et al (2012). United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis, 59(1 Suppl 1):A7, e1-420.
26. Malekmakan L, Haghpanah S, Pakfetrat M, et al (2009). Causes of chronic renal failure among Iranian hemodialysis patients. Saudi J Kidney Dis Transpl, 20(3):501-4.
27. Galabada DP, Nazar ALM, Ariyaratne P (2014). Survival of Living Donor Renal Transplant Recipients in Sri Lanka : A Single-Center Study. Saudi J Kidney Dis Transpl, 25(6):1334-40.
28. Courtney AE, McNamee PT, Maxwell AP (2008). The evolution of renal transplantation in clinical practice: for better, for worse? QJM, 101(12):967-78.
29. Feyssa E, Jones-Burton C, Ellison G, et al (2009). Racial/ethnic disparity in kidney transplantation outcomes: influence of donor and recipient characteristics. J Natl Med Assoc, 101(2):111-5.
30. Fuggle SV, Allen JE, Johnson RJ, et al (2010). Factors affecting graft and patient survival after live donor kidney transplantation in the UK. Transplantation, 89(6):694-701.
31. Morales JM, Marcén R, Castillo D, et al (2012). Risk factors for graft loss and mortality after renal transplantation according to recipient age : a prospective multicentre study. Nephrol Dial Transplant, 4(Suppl 4):iv39-46.
32. Chang SH, Coates PTH, McDonald SP (2007). Effects of Body Mass Index at Transplant on Outcomes of Kidney Transplantation. Transplantation, 84(8):981-7.
33. Lafranca JA, Ijermans JNM, Betjes MGH, et al (2015). Body mass index and outcome in renal transplant recipients : a systematic review and meta-analysis. BMC Med, 13:111.
34. Shahbazi F, Ranjbaran M, Karami-far S, et al (2015). Graft survival rate of renal transplantation during a period of 10 years in Iran. J Res Med Sci, 20(11): 1046–1052.
35. Javanrouh Givi N, Alimi R, EsmailyH, et al (2013). Assessment of effective factors on renal transplantation survival and estimation of rejection hazard for transplanted in Mashhad Qaem hospital. JNKUMS, 5(2): 315-321.
36. Matas AJ, Payne WD, Sutherland D, et al (2001). 2,500 living donor kidney transplants: a single-center experience. Ann Surg, 234(2): 149–164.
37. Meier-Kriesche H-U, Morris JA, Chu AH, et al (2004). Mycophenolate mofetil vs azathioprine in a large population of elderly renal transplant patients. Nephrol Dial Transplant, 19(11):2864-9.
38. Remuzzi G, Cravedi P, Costantini M, et al (2007). Mycophenolate mofetil versus azathioprine for prevention of chronic allograft dysfunction in renal transplantation: the MYSS follow-up randomized, controlled clinical trial. JASN, 18(6):1973-1985.
39. Chon SE, Lee KW, Joh JW, et al (2003). Factors affecting the graft survival in cadaver donor kidney transplantation. Transplant Proc, 35(1):147-8.
40. Veroux M, Grosso G, Corona D, et al (2012). Age is an important predictor of kidney transplantation outcome. Nephrol Dial Transplant, 27(4):1663-71.
41. Mirzaee M, Mohammad K, Mahmoodi M, et al (2014). Multi-state survival analysis in renal transplantation recipients. Iran J Public Health, 43(3):316-322.
IssueVol 50 No 10 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v50i10.7508
Kidney transplantation Graft survival Proportional hazards models Kidney failure Chronic; Survival rate

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Alimi R, Hami M, Afzalaghaee M, Nazemian F, Mahmoodi M, Yaseri M, Zeraati H. Factors Affecting the Long-Term Survival of Kidney Transplanta-tion in Northeastern of Iran between 2000 and 2015. Iran J Public Health. 2021;50(10):2076-2084.