Trends in the Causes of Death among Kidney Transplant Recipients in the United States (1996–2014)

Abstract

Background: Death with graft function remains an important cause of graft loss among kidney transplant recipients (KTRs). Little is known about the trend of specific causes of death in KTRs in recent years. Methods: We analyzed United States Renal Data System data (1996–2014) to determine 1- and 10-year all-cause and cause-specific mortality in adult KTRs who died with a functioning allograft. We also studied 1- and 10-year trends in the various causes of mortality. Results: Of 210,327 KTRs who received their first kidney transplant from 1996 to 2014, 3.2% died within 1 year after transplant. Cardiovascular deaths constituted the majority (24.7%), followed by infectious (15.2%) and malignant (2.9%) causes; 40.1% of deaths had no reported cause. Using 1996 as the referent year, all-cause as well as cardiovascular mortality declined, whereas mortality due to malignancy did not. For analyses of 10-year mortality, we studied 94,384 patients who received a first kidney transplant from 1996 to 2005. Of those, 22.1% died over 10 years and the causative patterns of their causes of death were similar to those associated with 1-year mortality. Conclusions: Despite the downtrend in mortality over the last 2 decades, a significant percentage of KTRs die in 10-years with a functioning graft, and cardiovascular mortality remains the leading cause of death. These data also highlight the need for diligent collection of mortality data in KTRs.

Human Papillomavirus Vaccination in Male and Female Adolescents Before and After Kidney Transplantation: A Pediatric Nephrology Research Consortium Study

“…The primary outcome was the antibody response to each of the four HPV serotypes contained within the vaccine (6,11,16,18). Serum was collected from all subjects on day 1 of enrollment prior to dose 1 of the vaccine administration [Time 1 (T1)] and at month 7 (or 1 month after vaccine series was completed) [Time 2 (T2)].…”

“…Solid organ transplant (SOT) recipients are at increased risk for malignancies in both pediatric and adult populations (1)(2)(3), with an elevated risk of dying of their cancer, even after adjustment for stage and treatment (4). Pediatric and adult kidney transplant (KT) recipients carry similar risk and malignancies are third most common cause of mortality within this population (5,6). Specifically, female KT recipients have an increased risk of cervical cancer up to 14-fold, vulvar cancer up to 50-fold and anal cancers up to 100-fold (7,8).…”

Longitudinal Analysis of Cardiovascular Risk Factors in Active and Sedentary Kidney Transplant Recipients

“…Cardiovascular disease (CVD) remains the main cause of death with functioning graft worldwide [3,4]. Therefore, the implementation of strategies to improve cardiovascular outcomes post-transplantation, including lifestyle interventions, represents an important challenge for transplant community researchers and clinicians [5].…”

Assessment of kidney transplant suitability for patients with prior cancers: is it time for a rethink?

“…Kidney transplantation is often the treatment of choice for a proportion of patients with end‐stage kidney disease (ESKD), conferring a significant survival advantage and improvement in quality of life compared to dialysis treatment . Advances in the management of cardiovascular disease (CVD) have resulted in a substantial reduction in CVD mortality in kidney transplant recipients, but despite improved access to cancer screening and novel treatment options, cancer remains a major cause of morbidity and mortality in this population . In Australia, cancer has surpassed CVD as the most frequent cause of mortality in kidney transplant recipients, with similar trends observed worldwide .…”

“…Advances in the management of cardiovascular disease (CVD) have resulted in a substantial reduction in CVD mortality in kidney transplant recipients, but despite improved access to cancer screening and novel treatment options, cancer remains a major cause of morbidity and mortality in this population . In Australia, cancer has surpassed CVD as the most frequent cause of mortality in kidney transplant recipients, with similar trends observed worldwide . Even though cancer is a feared complication for kidney transplant recipients, many patients would still consider this as an acceptable risk in the trade‐off between the risk of dying from cancer versus remaining on lifelong dialysis treatment .…”