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Abstrak :
[Latar Belakang Transplantasi ginjal adalah modalitas terapi pengganti ginjal yang paling baik bagi pasien dengan Penyakit Ginjal Tahap Akhir (PGTA). Saat ini di Indonesia transplantasi ginjal dengan donor hidup mulai semakin sering dilakukan, terutama di RSUPN Cipto Mangunkusumo, di mana dalam beberapa tahun terakhir lebih dari 50% kasus transplantasi ginjal di Indonesia dilakukan di rumah sakit ini. Walaupun demikian, data mengenai hasil transplantasi di Indonesia, baik kesintasan 1 tahun graft maupun pasien, serta faktor yang diduga mempengaruhinya masih belum ada. Diharapkan hasil transplantasi di rumah sakit ini dapat menggambarkan hasil secara keseluruhan di Indonesia. Metode Studi kohort retrospektif pada resipien transplantasi ginjal di RSUPN-CM dari Januari 2010 hingga Mei 2014. Data didapatkan dari penelusuran rekam medis serta menghubungi pasien secara langsung. Masing-masing resipien diikuti sejak tanggal transplantasi hingga kematian atau Mei 2015. Proporsi kesintasan graft dan pasien pada 1 tahun post transplantasi dan pada akhir studi didokumentasikan. Kurva Kaplan-Meier digunakan untuk menggambarkan kesintasan pasien secara keseluruhan. Studi deskriptif dilakukan dengan melihat perbedaan proporsi variabel serta perbedaan rerata atau median pada pasien yang mengalami kegagalan graft 1 tahun serta tidak, serta pasien yang bertahan hidup atau meninggal. Hasil Berdasarkan hasil consecutive total sampling didapatkan 157 resipien yang menjalani transplantasi ginjal di RSUPN-CM, 137 resipien di antaranya memenuhi kriteria penelitian, seluruhnya mendapatkan ginjal dari donor hidup. Usia resipien rata-rata adalah 47,9 ± 13,9 tahun, rerata IMT 22,8 ± 3,7 kg/m2, dan proporsi resipien dengan diabetes 35,8%. Didapatkan 7 pasien mengalami disfungsi graft primer (kegagalan transplantasi), sehingga 130 pasien diikuti untuk melihat kesintasan jangka panjang. Pada akhir tahun pertama, didapatkan angka death-censored graft survival adalah 95,4%, all-cause graft survival 85,4%, kesintasan pasien 88,5%, dan death with a functioning graft sebesar 10%. Pada akhir studi, didapatkan angka kesintasan tersebut berturut-turut adalah 94,6%, 80%, 82,3%, dan 14,6%, dengan median waktu pengamatan 24 bulan (1 ? 64 bulan). Kurva Kaplan Meier menunjukkan angka mortalitas tertinggi didapatkan pada bulan-bulan awal post transplantasi. Kegagalan graft dan kematian didapatkan lebih banyak pada resipien yang berusia lebih tua, mengidap diabetes melitus, serta memiliki indeks komorbiditas yang tinggi. Penyebab kematian utama adalah infeksi (11,5%) diikuti dengan kejadian kardiovaskular (3,8%). Simpulan Death-censored graft survival 1 tahun resipien transplantasi ginjal di Indonesia sudah sangat memuaskan. Angka death with functioning graft masih cukup tinggi, sehingga menurunkan all-cause graft survival dan kesintasan pasien 1 tahun. Walaupun demikian, secara keseluruhan hasil ini masih sebanding dengan negara-negara berkembang lainnya.;Background Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia. Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately. Results Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%). Conclusions The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries;Background Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia. Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately. Results Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%). Conclusions The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries;Background Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia. Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately. Results Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 ? 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%). Conclusions The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries, Background Kidney transplant is established as the preferred modality for end stage renal disease patients. Living donor kidney transplant is increasingly popular in Indonesia, especially in Cipto Mangunkusumo Hospital, comprising more than 50% of all transplant procedures performed in Indonesia. However, data regarding one-year graft and patient survival in Indonesia is still scarce. This single-center study is hoped to represent the characteristics and results of graft and patient survival of living donor kidney transplant in Indonesia. Methods A retrospective cohort study with total consecutive sampling is performed on all kidney transplant recipients in Cipto Mangunkusumo Hospital from January 2010 until May 2014. Data is acquired by analysing medical records and contacting patients directly. Each recipient is followed from the day of transplant until death or May 2015, whichever comes first. One-year graft and patient survival is documented. Kaplan-Meier Curve is used to describe patient survival until the end of study. Descriptive studies on risk factors of graft and patient survival is also conducted, using differences in proportions, means, and medians appropriately. Results Within the timeframe there are 157 recipients of living donor kidney transplants, 137 of which fulfill the inclusion criteria. The mean age is 47.9 ± 13.9 years, mean BMI is 22.8 ± 3.7 kg/m2, and 35.8% of all recipients are diabetics. Primary non-function/early transplant failure is present in 7 patients, so that 130 recipients are included for long term survival descriptions. In the end of the first year post transplant, death-censored graft survival is 95.4%, all-cause graft survival is 85.4%, patient survival is 88.5%, and death with a functioning graft is 10%. By the end of the study, the corresponding survival results are 94.6%, 80%, 82.3%, and 14.6%, respectively, with a median observation time of 24 months (1 – 64 months). Kaplan-Meier curve showed that the mortality rate is higher in the early months after transplant. More deaths and graft failures are found in older and diabetic recipients, as well as those with a high comorbidity index. The main causes of death are infections (11.5%) and cardiovascular diseases (3.5%). Conclusions The outcome of one-year death-censored graft survival in Indonesia is very satisfactory. The incidence of death with functioning graft is relatively high, causing a decline in one-year patient survival and all-cause graft survival. However, the overall results are still comparable to other developing countries]

Abstrak :
ABSTRAK Penderita gagal ginjal kronik progresif yang tidak dapat diatasi dengan pengobatan konservatif akan mengalami gagal ginjal tahap akhir. Untuk kelangsungan hidupnya, penderita gagal ginjal tahap akhir memerlukan terapi pengganti yang bisa berupa hemodialisis, dialisis peritoneal atau transplantasi ginjal (1,2). Penanggulangan gagal ginjal di Indonesia belum mencapai hasil yang diinginkan, walaupun sudah dilakukan sejak tahun 1960-an, karena sarana yang ada sekarang masih terbatas (3). Transplantasi ginjal yang berhasil sebenarnya merupakan cara penanggulangan gagal ginjal tahap akhir yang ideal karena dapat mengatasi seluruh jenis penurunan fungsi ginjal (3). Selain itu, transplantasi organ tubuh merupakan prosedur klinik yang sudah diterima di seluruh dunia (4). Cyclosporine-A (siklosporin) merupakan obat imunosupresif pilihan pada transplantasi organ karena sudah berhasil meningkatkan angka ketahanan hidup (survival) organ tanpa menimbulkan supresi sumsum tulang (5). Meskipun pada transplantasi ginjal siklosporin telah dapat meningkatkan angka ketahanan hidup ginjal dan penderita secara dramatis (6), obat ini mempunyai beberapa efek camping, antara lain yang terpenting adalah efek nefrotoksisitas (7). Efek nefrotoksisitas siklosporin dalam klinik dapat terjadi secara akut dan kronik. Mekanisme yang paling sering dikemukakan pada tipe akut adalah penurunan aliran darah ginjal akibat vasokonstriksi arterial aferen glomerulus. Sedangkan pada tipe kronik disebabkan oleh iskemia kumulatif, akibat vasokonstriksi arteriol aferen glomerulus pada fase akut dan lesi iskemik vaskuler yang berupa arteriolopati, akibat pengaktifan trombosit lokal (8). Efek nefrotoksisitas akibat penggunaan siklosporin jangka panjang yang berupa arteriolopati sukar dihambat, sedangkan efek vasokonstriksi akut siklosporin masih mungkin dikurangi, misalnya dengan penambahan obat seperti antagonis kalsium yang bisa menghambat efek vasokonsriksi lersebut. Antagonis kalsium dikenal sejak tiga dekade yang lalu, namun baru pada dekade terakhir golongan obat ini diselidiki secara lebih mendalam tentang manfaatnya terhadap fungsi ginjal (9). Antagonis kalsium [ermasuk dalam golongan obat antihipertensi yang pemakaiannya semakin banyak di Indonesia (10). Beberapa penelitian sudah dilakukan dengan mencoba memberikan antagonis kalsium bersama siklosporin, baik pada hewan percobaan maupun dalam penelitian klinik (11-13). Penelitian tersebut menyimpulkan bahwa antagonis kalsium verapamil dan diltiazem agaknya bermanfaat mengurangi nefrotoksisitas yang disebabkan oleh siklosporin, walaupun faktor yang berperan belum diketahui secara pasti. Antagonis kalsium verapamil dan diltiazem dilaporkan dapat meninggikan kadar siklosporin dalam darah resipien, yang disebabkan oleh metabolisme kompetitif pada sistem enzim sitokrom P-450 dalam hepar (14). Antagonis kalsium golongan dihidropiridin, kecuali nikardipin (15), dilaporkan tidak mengganggu metabolisme siklosporin, karena golongan that ini tidak terlalu terkonsentrasi dalam hepar (16). Amlodipin yang termasuk dalam golongan dihidropiridin generasi terbaru, mempunyai beberapa kelebihan dibandingkan dengan generasi sebelumnya. Kelebihan tersebut di antaranya adalah mempunyai rasio selektivitas vaskuler yang sangat tinggi dan dosis hanya sekali sehari, serta tidak menimbulkan efek inotropik negatif, aritmia dan tahikardia. Selain itu, efek samping seperti sakit kepala, pusing dan edema lebih ringan, dan lebih jarang terjadi (17). Amlodipin dengan dosis 5-10 mg sekali sehari sudah dibuktikan dapat menaikkan laju filtrasi glomerulus 13% dan aliran plasma ginjal efektif 19%, serta menurunkan resistensi vaskuler ginjal 25% pada penderita hipertensi esensial (18). Seperti diketahui laju filtrasi glomerulus dan aliran plasma ginjal efektif menggambarkan fungsi glomerulus dan tubulus, dan secara keseluruhan kedua fungsi tersebut juga menggambarkan fungsi ginjal. Siklosporin menyebabkan gangguan perfusi ginjal kemungkinan besar dengan Cara peningkatan tonus arteriol aferen glomerulus, karena obat ini sendiri bersifat vasokonstriktor (19). Siklosporin juga bisa menimbulkan efek vasokonstriksi tersebut secara tidak langsung, misalnya melalui stimulasi sistem renin-angiotensin (11) dan atau stimulasi sistem saraf simpatis (20), melalui stimulasi produksi hormon vasokonstriktor endotelin (21) atau akibat perubahan keseimbangan produksi prostaglandin lokal antara yang bekerja sebagai vasokonstriktor dan vasodilator (22). Efek nefrotoksik akut siklosporin yang khas adalah penurunan aliran plasma ginjal efektif dan laju filtrasi glomerulus sekitar 40 %, dan ini berarti bahwa fungsi ginjal transplan menjadi sekitar 60 % dari nilai semula (7). Penurunan kedua parameter ini umumnya sebanding sehingga fraksi filtrasi biasanya tidak banyak berubah (23). Penelitian yang dilakukan pada hewan percobaan menunjukkan bahwa antagonis kalsium meningkatkan aliran plasma ginjal efektif dan laju filtrasi glomerulus dengan cara pengurangan efek vasokonstriksi berbagai vasokonstriktor seperti angiotensin ll, norefinefrin, tromboksan, dan endotelin pada arterial aferen tanpa mempengaruhi tonus arteriol eferen (16). Pada resipien transplantasi ginjal yang mendapat siklosporin, penambahan antagonis kalsium amlodipin diharapkan akan dapat mengurangi efek vasokonstriksi arteriol aferen oleh siklosporin tersebut. Sampai saat ini belum ada data mengenai manfaat antagonis kalsium amlodipin terhadap penghambatan penurunan fungsi ginjal pada resipien transplantasi ginjal yang mendapat siklosporin. Selain itu, pengetahuan tentang mekanisme yang mendasari manfaat tersebut sangat menarik untuk diselidiki. Andaikan memang benar bermanfaat, namun masih belum diketahui pula apakah penghambatan penurunan fungsi ginjal oleh amlodipin tersebut melalui penurunan sintesis berbagai vasokonstriktor ataukah melalui cara lain.

Abstrak :
Latar Belakang. Transplantasi ginjal masih menjadi pilihan terbaik sebagai terapi pengganti ginjal terutama pada pasien penyakit ginjal stadium akhir, yang dapat meningkatkan kualitas hidup terkait kesehatan dari berbagai aspek terutama aspek kesehatan fisik dan fungsi psikososial dan dapat menurunkan efek penyakit serta dapat mengurangi risiko kematian bila dibandingkan dengan terapi konservatif. Penelitian ini bertujuan untuk mengetahui status kualitas hidup resipien setelah menjalani transplantasi ginjal beserta faktor-faktor yang berhubungan. Metode. Penelitian ini menggunakan desain potong lintang. Subyek penelitian adalah pasien penyakit ginjal kronik yang telah menjalani transplantasi ginjal di RS dr. Cipto Mangunkusumo dari Januari 2018-Desember 2020. Penilaian kualitas hidup dilakukan dengan menggunakan kuesioner SF-36. Dilakukan analisis univariat, bivariat, dan multivariat pada variabel independen baik terhadap 8 domain dari SF-36, komponen MCS dan PCS, serta skor total keseluruhan dari SF-36. Hasil. Durasi dialisis, kadar hemoglobin, ECOG dan depresi berkontribusi terhadap komponen PCS kualitas hidup (R2= 21,4%), sedangkan kadar hemoglobin dan depresi berkontribusi terhadap komponen MCS (R2= 33,6). Sedangkan faktor-faktor yang berhubungan dengan kualitas hidup secara keseluruhan adalah kadar hemoglobin, ECOG dan depresi (R2=40,7%). Kesimpulan. Kualitas hidup resipien pasca transplantasi ginjal secara keseluruhan pada penelitian ini tinggi, dengan kualitas hidup pada komponen fisik lebih tinggi bila dibandingkan dengan komponen mental. Adapun faktor-faktor yang berkontribusi dan bermakna secara statistik terhadap keseluruhan kualitas hidup adalah kadar hemoglobin, status ECOG, dan depresi. Namun di samping itu, durasi dialisis dan ECOG juga berkontribusi terhadap komponen fisik terhadap kualitas hidup. ......Objective. This study aims to determine and identify factors associated with QoL after kidney transplantation. Methods. This study used a cross-sectional design. We enrolled 107 consecutive subjects who had kidney transplantation at the Kidney transplantation center at Dr. Cipto Mangunkusumo General Hospital. from January 2018-December 2020. QoL was performed by the SF-36 questionnaire. Univariate, bivariate, and multivariate analyzes were performed on the independent variables and dependent variable (SF-36). Each analyzes of independent variables divided into 8 domains, the MCS and PCS components, and the overall total score of the SF-36. Result. Duration of dialysis, hemoglobin levels, ECOG and depression were contributed to the PCS component of quality of life (R2= 21.4%) while hemoglobin levels and depression contributed to the MCS component (R2= 33.6). And factors related to total score of SF-36 were hemoglobin levels, ECOG status, and depression (R2=40.7%). Conclusion. We found that overall QoL status after kidney transplantation in this study was high, with the PCS component being higher than MCS component. Factors that contributed and were statistically significant to Qol status were hemoglobin levels, ECOG status, and depression. Besides, the duration of dialysis and ECOG status also contributed to the physical component of SF-36.

Abstrak :
ABSTRACK
Transplantasi ginjal dapat mengalami komplikasi delayed graft function yang merupakan salah satu bentuk gangguan ginjal akut. Terdapat banyak faktor yang dapat memengaruhi delayed graft function, yakni faktor intraoperatif dan ekstraoperatif. Studi ini meneliti faktor-faktor yang dapat menyebabkan delayed graft function pada faktor ekstraoperatif khususnya dari segi donor dan resipien. Tujuan: Mengetahui hubungan antara faktor donor (usia, hubungan kekerabatan dengan resipien) dan faktor resipien (usia, penyebab gagal ginjal) dengan kejadian delayed graft function pada resipien. Metode: penelitian ini menggunakan metode studi potong lintang dan melibatkan 483 sampel yang merupakan pasien transplantasi ginjal di RSCM periode November 2011-September 2018. Hasil: chi square dan fisher menunjukkan bahwa terdapat hubungan yang bermakna antara usia donor (p=0,023), usia resipien (p=0,006), dan hubungan kekerabatan donor dan resipien (p=0,008) dengan delayed graft function. Tidak terdapat hubungan antara penyebab gagal ginjal diabetes mellitus, hipertensi, infeksi, penyakit autoimun, dan penyebab lain gagal ginjal. Diskusi: Dari analisis multivariat didapatkan adanya hubungan bermakna antara hubungan kekerabatan donor dan resipien dengan delayed graft function (p= 0,011. Disimpulkan bahwa hubungan kekerabatan donor dan resipien merupakan faktor yang paling berhubungan dengan terjadinya delayed graft function pada resipien transplantasi ginjal RSCM dibandingkan dengan faktor usia donor, usia resipien, dan penyebab gagal ginjal resipien. ABSTRACT
Background: Kidney transplant patients may have complications, such as delayed graft function which is one of acute kidney injury. There are a lot of factors that can affect delayed graft function, such as intraoperative and extraoperative factors. In this study we discussed more about extraoperative factors, specifically from donor and recipient factors. Objective: To determine the association between donor factors (age, relation with recipien)t, recipient factors (age, cause of kidney failure) and delayed graft function in transplant recipient. Methods: Cross-sectional study design was used in this study  by collecting 483 patient data of medical record from data recapitulation of renal transplant by Departement of Urology, Cipto Mangunkusumo National Hospital, from November 2011-September 2018. Results: Bivariat analysis with chi square and fisher test result showed that there was a significant association between donor age (p=0,023), recipient age (p=0,006) and donor and recipient relation status (p=0,008) with delayed graft function. There were no significant association between recipient age, and causes of kidney failure. Discussion: From the multivariate analysis it was found that there was a significant association between donor and recipient relation status (p=0,011) with delayed graft function.From these result we concluded that donor and relation status are the most  associated factor with delayed graft function in recipients.