Death with graft function after kidney transplantation: a single-center experience

Abstract

BackgroundDeath with graft function (DWGF) is an important cause of long-term loss of grafts and patients. In this study, we investigated clinical characteristics and causes of DWGF in kidney transplant recipients.MethodsWe recruited kidney allograft recipients who underwent surgery during 1973–2016 at Seoul National University Hospital in Korea (n = 2137). We divided recipients into four groups: alive with graft function (AWGF), alive with graft loss (AWGL), DWGF, and death with graft loss (DWGL).ResultsAmong 455 recipients with graft loss, 88 (19.3%) lost graft function due to death. DWGF was responsible for 38.6% of a total of 228 deaths. Recipients with DWGF were older, more often diabetic, and experienced delayed graft function more often compared to patients with AWGF, AWGL, and DWGL. Additionally, they had fewer episodes of acute rejection than AWGF and AWGL patients. The majority of DWGF developed because of infection (40.9%), malignancy (28.4%), and cardiovascular disease (11.4%). Infection-related mortality was highest within the first year after transplantation. Death due to malignancy was lowest within the first year, but increased thereafter.ConclusionsIn our center, DWGF was a significant cause of graft loss. Infection and malignancy were the leading causes of DWGF during the overall post-transplantation period. Therefore, close monitoring for infection and malignancy should be instituted to lessen the burden of graft loss.

Trends in the effects of pre‐transplant diabetes on mortality and cardiovascular events after kidney transplantation

“…Since the 1990s, atherosclerotic cardiovascular disease has replaced infection as the leading cause of post-transplant death in the USA 29 . Infection-related death is still the most common cause of death in Korean kidney recipients, and cardiovascular mortality is the second-highest cause of post-transplant death 30 . Infection-related and cardiovascular mortality was higher in recipients with pre-transplant diabetes than in those without diabetes; however, the difference disappeared after adjusting for confounding factors due to a small number of events.…”

Oral/oesophageal candidiasis is a risk factor for severe infection after kidney transplantation

“…In this study, viral infections were not considered severe infections because death and kidney graft loss after kidney transplantation are often caused by bacterial infections 4,5 . In contrast, herpesvirus, herpes zoster virus, and cytomegalovirus are common viral infections after kidney transplantation, but they are rarely life‐threatening.…”

“…In this study, viral infections were not considered severe infections because death and kidney graft loss after kidney transplantation are often caused by bacterial infections. 4 , 5 In contrast, herpesvirus, herpes zoster virus, and cytomegalovirus are common viral infections after kidney transplantation, but they are rarely life‐threatening. In addition, cytomegalovirus infection after kidney transplantation is difficult to evaluate appropriately because the risk of onset and treatment modifications, such as prophylactic administration of antiviral drugs, depend on the patient's background (e.g., antibody presence or absence in donor and recipient).…”

Time-Varying Proteinuria and the Risk of Cardiovascular Disease and Graft Failure in Kidney Transplant Recipients

“…1–4 The rates of cardiovascular events and cardiovascular mortality in kidney transplant recipients are 50 times and 10 times higher than in the general population, respectively. 5 Moreover, approximately half of recipients die with a functioning graft 6 and about 30% of these deaths are attributable to CVD. 7…”