Early Graft Loss After Kidney Transplantation: Risk Factors and Consequences.

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The increasing use of kidneys from marginal donors may be associated with a higher risk of early graft loss, which is a potentially catastrophic outcome. However, the risk factors and consequences of early graft loss after kidney transplantation have not previously been examined among different donor types. Recipients of kidney-only transplants between January 2002 and April 2012 in our centre who suffered graft loss within 30 days were identified from a prospectively-maintained database. Factors associated with early graft loss were determined by multivariate analysis. Within the study period,1090 patients received a kidney-only transplant: 435 (39.9%) received grafts from donors after circulatory death (DCD), 366 (33.6%) from donors after brain death (DBD) and 289 (26.5%) from living donors. Early graft loss occurred in 52 (4.8%) recipients. Causes included acute vascular occlusion (19; 1.7%), primary non-function (19; 1.7%), haemorrhage (7; 0.6%) and rejection (3; 0.3%). Only DCD donor type was a significant risk factor for early graft loss (p=0.006), although one-year graft survival after DCD and DBD transplantation was similar (89.9% vs 93.2%; p=0.089). Patients with early graft loss had 8.5 times increased risk of death (p<0.001; figure 1); their one-year patient survival was less than those on the waiting list (76.9% vs 88.8%), but 5-year patient survival in the early graft loss group was better (69.3% vs 51.4%; log-rank test: p=0.030). Re-transplantation after early graft loss was associated with a good outcome with a one-year graft survival of 86.7%. Our findings suggest that DCD donation is a significant risk factor for early graft loss. Early kidney graft loss, irrespective of donor type, is a major risk factor for patient mortality. However, long-term patient survival after early kidney graft loss is still superior to the survival of those who remain on the waiting list. Kidney re-transplantation was associated with a high success rate and should be considered.Figure: No Caption available.