Survival and mortality of kidney transplant patients in Costa Rica 2019-2023

Abstract

Aim: To determine the survival of patients receiving kidney transplants in Costa Rica, the factors associated with it, and differences between hospitals.

Methods: Time-survival data from 292 KTs performed in five hospitals in Costa Rica from 2019 to 2023. Mortality rates (hazards) per transplanted person-year. Kaplan-Meier survival curves. Relative risks of death by characteristics, estimated with Cox multiple regression.

Results: The 5-year post-transplant survival rate was 78%; the average of 91% for living donor transplants and 69% for cadaveric donor. The risk of death for the latter is critically high in the first six months post-transplant with a annualized death rate of 26%, which is almost six times higher than in the following 4.5 years and that of the living donor transplants.  Patients who survived the first six months post-transplant had a mortality rate eight times higher than the general population.  The small number of observations in the database did not allow for the identification of significant mortality differences between  hospitals.  Mortality among patients transplanted during the COVID-19 pandemic was not higher than in other years.

Conclusions: Compared to successful countries, the survival rate of kidney transplant patients in Costa Rica is high and similar to those countries for living donors, but lower for deceased donors, indicating room for improvement. Kidney transplant patients are at high risk of dying, especially in the first months after transplantation. The existence of a national transplant registry has made it possible to estimate the survival and mortality rates of recipients nationwide for the first time. It is important that this registry be kept up-to-date and expanded with information that will help optimize the kidney transplant program.