Patient's Death with a Functioning Graft is still the Most Common Cause of Kidney Transplant Loss

Abstract

Introduction and Aims Kidney transplantation is the best and the most cost-effective modality of renal replacement therapy for patients with end stage chronic kidney disease. The mortality rate is higher in these patients than in general population, mainly caused by cardiovascular disease (CV). Death with a functioning graft (DWF) has increased over the decade, mitigating improvements in overall graft survival, probably due to older patient population with greater comorbidities who continue to have chronic immunosuppressive treatment. The ratio of mortality either by infectious or tumoral diseases has also highly increased. The causes of kidney allograft loss remain unclear. We investigated these causes in 1446 kidney transplant recipients. Our objective was to identify the main causes of mortality of renal transplant patients in our hospital. We described the global frequency of death with function (DWF), as well as the main causes of mortality in our patients. Methods It is a descriptive and transversal study in 1446 kidney transplant recipients followed-up in outpatient clinic, where frequency of death and most common causes were analyzed. Results During the follow-up, death with function (DWF) was the single most commonly observed cause of graft loss, 244 grafts,16,9% of all transplants. The frequency of death before discharge was 1.5% (N=22), before one year posttransplant 3.3% (N=48) and global mortality(16,9%)%)(N=244). The first cause of death was Cardiovascular(36,2%), followed by infections (22,3%) and malignancies(17,5%). There were no differences in the causes of death that occurred during the first year and more than 1 year posttransplant. 63,5% of the patients had at least one hospitalization after trasplantation, which 9,7% did at ICU. The most frequent maintenance for immunosuppressive regimen was tacrolimus+micofenolate (MMF)+prednisone (24,9%) The remaining functioning grafts were lost due to a variety of causes, including glomerular diseases (recurrent, transplant glomerulopathy, nonrecurrent) interstitial fibrosis/ tubular atrophy (IF/TA) and acute rejection (either celular or antibody-mediated). Conclusion Patient´s death with a functioning graft (DWF) has increased over the decade, mitigating improvements in overall graft survival, probably due to older patient population with greater comorbidities and it is still the most common cause of graft loss. Being the first cause of death cardiovascular, followed by infections, malignancies and others.