Introduction: Kidney transplantation (KT) remains the main renal replacement therapy option for end-stage renal disease. Recipient survival rates are an important issue of interest after KT. Kidney transplantation has been developing rapidly in Indonesia in recent years. However, data regarding mortality predictor factors has not been widely studied. This study aims to analyze predictor factors for recipient mortality after KT.
Methods: Retrospective cohort study of 60 adult patients who underwent KT with living kidney donors at Dr Sardjito Hospital, Indonesia. Several parameters related to recipient, donor, ischemic time and laboratory parameters were analyzed in this study. The cut-off values of Tacrolimus through, Monocyte-Lymphocyte Ratio (MLR), Netrophil-Lymphocyte Ratio (NLR), and Platelet-Lymphocyte Ratio (PLR) were assessed with receiver operating characteristic (ROC) curves. Predictor factor analysis used bivariate tests followed by multivariate tests.
Results: More than half of the subjects were male (75%) and the mean age was 39±12.89 years.

NLR values >9.58 and PLR >45.17 at 2 weeks after KT can increase the risk of mortality but are not statistically significant (RR 2.0, 95% CI 0.65-6.11, p=0.278 and RR 1.56, 95% CI 0.59-4.86, p=0.468, respectively). Meanwhile, the results of multivariate analysis showed that tacrolimus trough levels <7.74 ng/mL and MLR > 0.99 at 2 weeks after KT significantly increased the risk of higher mortality with OR: 13.229, 95% CI:1.358-128.920, p=0.026 and OR: 7.478, 95% CI: 1.398-40.011, p=0.019, respectively. Tacrolimus through and MLR levels at 2 weeks after KT can strongly predict mortality with an AUC of 80.6% (95% CI 0.643-0.963, p=0.002).

Conclusion: Tacrolimus trough levels <7.74 ng/mL and MLR > 0.99 at 2 weeks after KT can be predictors of mortality in kidney transplant recipients. MLR, a cheap and widely available parameter, is a reliable marker in predicting post-KT recipient mortality.