Death with Functioning Graft in Living Donor Kidney Transplantation: Analysis of Risk Factors

Abstract

Background: Death with a functioning graft (DWF) has been reported as a major cause of graft loss after renal transplantation. It has been reported to occur in 9–30%. Methods: From March 1976 to January 2002, a total of 1,400 living donor renal transplants were performed in our center. Out of 257 reported deaths among our patients, 131 recipients died with functioning grafts after a mean period of 53.4 ± 53.2 months. Results: DWF patients account for 27% of all graft losses in our series. The mean age was 34.9 + 10.6 (range 8–62 years), 98 of them were male and 33 were female. The original kidney disease was GN in 9, PN in 24, PCK in 5 and nephrosclerosis in 8 patients. Acute rejection episodes were diagnosed in 84 patients (63.1). The post-transplant complications encountered were hypertension in 78 patients (59.5%), diabetes mellitus in 30 patients (22.9%), medical infections in 68 (51.5%), hepatic complications in 30 (22.9%) and malignancy in 17 patients (13%). The main causes of death in these patients were infections in 46 (35.6%), cardiovascular in 23 (17.6%), liver cell failure in 15 patients (11.4%) and malignancy in 8 (6.1%). The mean serum creatinine was 2 ± 0.6 mg/dl at last follow-up before death. Conclusion: We conclude that the relatively higher mortality in renal transplantation is, in part, due to co-morbid medical illness, pre-transplant dialysis treatment, and factors uniquely related to transplantation, including immunosuppression and other drug effects. DWF must be in consideration when calculating graft survival.

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

“…13,14 The main causes of death included cardiac problems, malignancy, and infection, and causes of graft failure included recurrent disease and chronic rejection. 15,16 In a retrospective review of 4483 adult primary liver transplant recipients, major causes of death were malignancy (30.6%), multisystem failure (10%), infection (9.8%), graft failure (9.8%), and CVD (8.7%). 17 El-Agroudy et al 15 found the main causes of death in kidney allograft recipients were infections (35.6%), CVD (17.6%), liver disease (11.4%), and malignancy (6.1%).…”

“…15,16 In a retrospective review of 4483 adult primary liver transplant recipients, major causes of death were malignancy (30.6%), multisystem failure (10%), infection (9.8%), graft failure (9.8%), and CVD (8.7%). 17 El-Agroudy et al 15 found the main causes of death in kidney allograft recipients were infections (35.6%), CVD (17.6%), liver disease (11.4%), and malignancy (6.1%). Of nearly 1600 kidney recipients in Japan, Shimmura et al 16 found the main causes of death with a functioning graft were infection (24%), stroke (17%), CVD (16%), malignancy (15%), and liver failure (12%).…”

“…15 Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Spain. www.transplantjournal.com S1 S olid organ transplantation has evolved from an experimental procedure to an established treatment option for many types of end-stage organ failure.…”

Causas de muerte en pacientes con un injerto renal funcionante: ¿Han ocurrido cambios en las últimas décadas?

“…l trasplante renal (TxR) ofrece expectativas de sobrevida y calidad de vida mejores que la permanencia en diálisis crónica (DC) a los pacientes con insufi ciencia renal crónica (IRC) 1,2 . Actualmente, la sobrevida de los sujetos que reciben un TxR es del orden de 95% al año y de 90% a los 3 a 5 años de la intervención 3 .…”

“…La nefropatía crónica del injerto y la muerte con riñón funcionante (MCRF) son las principales causas de pérdida de los TxR después del primer año de la intervención, resultando en una pérdida anual de 3-5% de los injertos [1][2][3][4][5][6][7] . Si bien la mortalidad de los pacientes trasplantados es inferior a la de los sujetos que permanecen en DC, su sobrevida es inferior a la de controles pareados por edad en la población general [1][2][3][4][8][9] . La mortalidad es 14,7 veces mayor durante el primer año del TxR y 4,4 veces mayor después de este período 1,10 .…”