Tesis

Kesintasan graft 5 tahun pasca-transplantasi ginjal donor hidup di RSUPN dr. Cipto Mangunkusumo dan faktor-faktor yang memengaruhinya = The 5-year graft survival after transplantation of living kidney donors at RSUPN dr. Cipto Mangunkusumo and the factors that influence it.

Latar Belakang. Pasien dengan gagal ginjal kronik di Indonesia mengalami peningkatan cukup pesat. Transplantasi ginjal merupakan terapi definitif pada pasien gagal ginjal tahap akhir. Saat ini, belum ada data mengenai kesintasan graft 5 tahun pasca-transplantasi ginjal di Indonesia. Di Indonesia sendiri belum diketahui mengenai faktor-faktor yang memengaruhi kesintasan graft pasca-transplantasi ginjal. Metode. Sebanyak 344 pasien yang menjalani transplantasi ginjal di RSUPN dr. Cipto Mangunkusumo periode tahun 2011 sampai 2016 dinilai kesintasan graft 5 tahun pasca-transplantasi ginjal dengan metode Kaplan-Meier. Kemudian dilakukan analisis bivariat mengenai faktor-faktor yang berperan dalam kesintasan graft dengan uji regresi cox dan didapatkan nilai Hazard Ratio, kemudian dilanjutkan dengan analisis multivariat regresi cox. Hasil. Nilai kesintasan graft 5 tahun pasca transplantasi ginjal di RSUPN dr. Cipto Mangunkusumo adalah 69% untuk kesintasan all-cause graft dan 78% untuk kesintasan death-censored graft. Faktorfaktor yang bermakna secara statistik dalam memengaruhi kesintasan all-cause graft pasca-transplantasi pada analisis bivariat adalah level kreatinin 1 bulan pasca-transplantasi lebih dari 1,5 mg/dl (HR 8,691, p < 0,001), rejeksi akut (HR 21,840, p < 0,001), IgG CMV resipien negatif (HR 1,790, p 0,012), etiologi gagal ginjal DM tipe 2 (HR 2,047, p 0,029) dan lamanya dialisis lebih dari 36 bulan (HR 3,283, p < 0,001). Faktor-faktor yang bermakna secara statistik dalam memengaruhi kesintasan death-censored graft pascatransplantasi ginjal pada analisis bivariat adalah level kreatinin 1 bulan pasca-transplantasi lebih dari 1,5 mg/dl (HR 8,760, p < 0,001), rejeksi akut (HR 23,141, p < 0,001), IgG CMV resipien negatif (HR 2,615, p < 0,001) dan lamanya dialisis lebih dari 36 bulan, (HR 2,840, p < 0,001). Kesimpulan. Kesintasan graft 5 tahun pasca-transplantasi ginjal di RSUPN dr. Cipto Mangunkusumo adalah 69% untuk kesintasan all-cause graft dan 78% untuk kesintasan death-censored graft. Pada analisis multivariat didapatkan bahwa faktor rejeksi akut, level kreatinin pasca-transplantasi ginjal dan IgG CMV resipien merupakan faktor yang memengaruhi kesintasan graft pasca-transplantasi ginjal.
Kata Kunci : Kesintasan graft 5 tahun, transplantasi ginjal, faktor yang memengaruhi kesintasan


Background. Patients with chronic kidney failure in Indonesia have increased quite rapidly. Kidney transplantation is the definitive therapy in patients with end-stage renal failure. Currently, there are no data regarding 5-year graft survival after kidney transplantation in Indonesia. In Indonesia itself, it is not known about the factors that influence graft survival after kidney transplantation. Method. A total of 344 patients who underwent kidney transplantation at RSUPN dr. Cipto Mangunkusumo for the period 2011 to 2016 was assessed for 5-year graft survival after kidney transplantation using the Kaplan-Meier method. Then a bivariate analysis of the factors that play a role in graft survival was carried out with the cox regression test and the Hazard Ratio value was obtained, then continued with multivariate cox regression analysis. Results. The 5-year graft survival rate after kidney transplantation at RSUPN dr. Cipto Mangunkusumo was 69% for all-cause graft survival and 78% for death-censored graft survival. Factors that were statistically significant in influencing post-transplant all-cause graft survival in bivariate analysis were creatinine level after transplantation > 1.5 mg/dl (HR 8.691, p < 0.001), acute rejection (HR 21.840 , p < 0.001), recipient's CMV IgG (-) (HR 1.790, p 0.012), type 2 diabetes as an etiology of renal failure (HR 2.047, p 0.029) and duration of dialysis > 36 months (HR 3.283, p < 0.001). Factors that were statistically significant in influencing death-censored graft survival after kidney transplantation in bivariate analysis were creatinine levels after transplantation > 1.5 mg/dl (HR 8.760, p < 0.001), acute rejection (HR 23,141, p < 0.001), recipient's CMV IgG (-) (HR 2.615, p < 0.001) and the duration of dialysis > 36 months, (HR 2.840, p < 0.001). Conclusion. The 5-year graft survival after kidney transplantation at RSUPN dr. Cipro Mangunkusumo was 69% for all-cause graft survival and 78% for death-censored graft survival. In multivariate analysis, it was found that acute rejection, creatinine levels after transplantation and recipient’s CMV IgG were factors that influenced graft survival after kidney transplantation.
Keywords: The 5-year graft survival, kidney transplantation, factors that affect survival.