Alzayer, Maha A.. The influence of deceased kidney donor blood urea nitrogen (BUN) level on graft and patient survival time. Retrieved from https://doi.org/doi:10.7282/T3NV9N1B
DescriptionAlthough the advancement of surgical techniques and immunosuppressive therapy has significantly improved the outcomes of kidney transplantation in patients with end stage renal disease (ESRD), post-transplantation outcomes remain a big challenge. Accordingly, the goal of this dissertation was to determine which variables might have the most critical impact on the graft and patient survival time. One such variable which seemed significant but not well studied was the Blood Urea Nitrogen (BUN) level of the donor. Therefore, using the United Network for Organ Sharing (UNOS) registry database (October 1987 to March 2016), a retrospective (longitudinal) cohort study was setup to examine the relationship between the BUN level of the deceased donor and the survival of the graft and the patient while controlling for certain other variables. The final sample consisted of 168,081 patients in the United States. Multivariate cox regression analysis revealed that high log BUN level of deceased donor remained an independent predictor of graft loss (hazard ratio [HR], 1.080; 95% hazard ratio confidence limits [CI], 1.032 - 1.131; P = 0.0009) and patient death (hazard ratio [HR], 1.063; 95% hazard ratio confidence limits [CI], 1.007 - 1.121; P = 0.0262) compared to low log BUN level of deceased donor. Significant findings from this study indicate that high log BUN level (> 2.79 mg/dl) of deceased donor is independently associated with decreased graft and patient survival time compared to low log BUN level of deceased donor. It is to be noted that White, Black and Hispanic donors races have significant differences at 5 year graft and patient survival time while donors of other races (Asian, American Indian/Alaska native, Native Hawaiian/other Pacific Islander, and multiracial) did not show a statistically significant influence on graft and patient survival due to genetic influences. These results can potentially contribute to a more efficient allocation of resources to donor sources with better outcome prospect.