Death within the first year after kidney transplantation - an observational cohort study

Farrugia, Daniela; Cheshire, James; Begaj, Irena; Khosla, Sajan; Ray, Daniel; Sharif, Adnan

doi:10.1111/tri.12218

Cited by 44 publications

(51 citation statements)

References 13 publications

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“…Death with a functioning graft occurred in 1.7% of patients in our material during the first year after transplantation, which is somewhat lower compared to previous reports . Interestingly, the most common causes of death during the first year after transplantation were cardiovascular, and not infectious causes, and the risk of infectious death during the first post‐transplant year in our current study was only 0.5%.…”

Section: Discussioncontrasting

confidence: 84%

Early failure of kidney transplants in the current era-a national cohort study

et al. 2018

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Although short-term outcome after kidney transplantation has improved, a small proportion of grafts are lost during the first year. We characterize in detail all early graft losses in the current era in a nationwide cohort of kidney transplant recipients. Altogether 2447 kidney transplantations, performed between June 2004 and October 2016, were included. All graft losses (return to dialysis or patient death) occurring during the first post-transplant year were characterized. During the first post-tranplant year, altogether 109 grafts were lost, 67 grafts failed, and 42 patients died. Fifty-five per cent of the deaths were due to cardiovascular causes, and 29% due to infectious causes. Twenty-one per cent of the failed grafts were primary nonfunction of unknown reason, 34% were lost due to venous thrombosis and 9% due to arterial thrombosis, but only 10 (15%) patients lost a graft due to acute cellular or humoral rejection. Independent risk factors for death included diabetes, and longer duration of pretransplant dialysis treatment, whereas risk factors for graft failure included increased level of panel-reactive antibodies and increased cold ischaemia time. Kidney allografts are rarely lost due to immunological reasons during the first post-transplant year. The most common causes of early death after transplantation are cardiovascular and infectious causes.

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Section: Discussioncontrasting

confidence: 84%

Early failure of kidney transplants in the current era-a national cohort study

et al. 2018

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“…Around one third of patients undergoing assessment for renal transplant have a significant burden of CAD, identified by coronary angiogram [18] , and 2.6%4.7% have had a MI prior to their transplant [19] with 6.8% requiring revascularisation [20] . Current guidance suggests that routine coronary angiogram should only be considered in those who are highrisk (age > 50, diabetes, previous cardiac event), as only a small number of patients have CAD which subsequently requires revascularisation and there is no effect on the perioperative rates of CV events [21] .…”

Section: Traditional Risk Factorsmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

116

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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“…Recipients of kidney transplants are a very heterogeneous patient population, and the risks for rejection and infection markedly vary among different patient subgroups (9,10). Although it seems obvious that immunosuppression should be adapted according to the individual patient risk profile, there is still no established approach to assess it.…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification for Rejection and Infection after Kidney Transplantation

Cippà¹,

Schiesser²,

Ekberg

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Definition of individual risk profile is the first step to implement strategies to keep the delicate balance between under-and overimmunosuppression after kidney transplantation. Results Despite different temporal dynamics, rejections and severe infections had similar overall incidences in the first year after transplantation (23.4% and 25.5%, respectively), and infections were the principal cause of death (43.2% of all deaths). Recipient older age, deceased donor, higher number of HLA mismatches, and high risk for cytomegalovirus disease were associated with infection; deceased donor, higher number of HLA mismatches, and immunosuppressive therapy including cyclosporin A (compared with tacrolimus), with rejection. These factors were integrated into a two-dimensional risk stratification model, which defined four risk groups: low risk for infection and rejection (30.8%), isolated risk for rejection (36.1%), isolated risk for infection (7.0%), and high risk for infection and rejection (26.1%). In internal validation, this model significantly discriminated the subgroups in terms of composite end point (low risk for infection/rejection, 24.4%; isolated risk for rejection and isolated risk for infection, 31.3%; high risk for infection/rejection, 54.4%; P,0.001), rejection episodes (isolated risk for infection and low risk for infection/rejection, 13.0%; isolated risk for rejection and high risk for infection/ rejection, 24.2%; P=0.001), and infection episodes (low risk for infection/rejection and isolated risk for rejection, 12.0%; isolated risk for infection and high risk for infection/rejection, 37.6%; P,0.001). External validation confirmed the applicability of the model to an independent cohort.Conclusions We propose a two-dimensional risk stratification model able to disentangle the individual risk for rejection and infection in the first year after kidney transplantation. This concept can be applied to implement a personalized immunosuppressive and antimicrobial treatment approach.

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Death within the first year after kidney transplantation - an observational cohort study

Cited by 44 publications

References 13 publications

Early failure of kidney transplants in the current era-a national cohort study

Early failure of kidney transplants in the current era-a national cohort study

Cardiovascular risk factors following renal transplant

Risk Stratification for Rejection and Infection after Kidney Transplantation

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