Facteurs prédictifs de l'échec de la transplantation rénale chez les enfants et les adultes jeunes Tunisiens : une étude rétrospective.
DOI :
https://doi.org/10.62438/tunismed.v102i1.4328Mots-clés :
Transplantation rénale, facteurs prédictifs, donneurs vivants, donneurs décédés, survie du greffon, échec de la transplantationRésumé
Introduction : La transplantation rénale est la thérapie de choix au cours de l'insuffisance rénale terminale pédiatrique.
Objectif : Identifier les facteurs prédictifs d’échec de la transplantation rénale chez les enfants et les jeunes adultes Tunisiens.
Méthodes : Il s’agissait d’une étude rétrospective bi centrique portant sur des enfants et des adultes jeunes (âge ≤ 20 ans) ayant eu une transplantation rénale entre 1989 et 2019. Nous avons analysé les taux de survie à long terme et les complications après la transplantation rénale. Ont été étudié les facteurs prédictifs de la perte du greffon. Nous avons utilisé une analyse univariée et une analyse multivariée pour identifier les facteurs prédictifs de la survie du greffon.
Résultats : Au total de 112 patients ont eu 115 transplantations rénales. Une défaillance du greffon était survenue dans 30% des cas. Les taux de survie du greffon à 1, 3, 5 et 10 ans étaient respectivement de 92%, 89,1%, 85,9% et 74,5%. Les paramètres suivants ont fortement influencé la survie du greffon : le schéma immunosuppresseur reposant sur une association autre que mycophénolate mofétil - tacrolimus et corticostéroïdes (p=0,02), l'année de la transplantation (p<0,0001 pour 1987-2000), le donneur en état de mort encéphalique (p=0,039), l'étiologie sous-jacente de l'insuffisance rénale terminale (p=0,045), la survenue de rejet aigu ou chronique (p<0,001), une protéinurie supérieure à 0,3 g/l par jour (p=0,002), la survenue de complications urologiques en post-greffe (p=0.002), et une créatinine sérique à 5 ans>1.28 mg/dl (p<0.001). Les taux de survie....( résumé tronqué à 250 mots).
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