Prevalence and risk factors for death with graft function among Egyptian kidney transplant recipients in Mansoura

Abstract

Background: Death 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 among kidney transplant recipients in Mansoura from 2002 to 2019. Methods: From March 2002 to December 2018, a total of 1,499 living donor renal transplants were done in Mansoura. Their data was retrospectively analyzed. Out of 285 reported deaths, 193 patients died with good graft function without need of dialysis.Results: Death with graft function occurred in about 27% of kidney transplant recipients at mean age 36 +10.7 years. Males were 140 (72.5%). They reached end stage renal disease (ESRD) secondary to GN in 14, PN in 35, PCK in 7 and nephrosclerosis in 12 patients. 125 patients had acute rejections (64.8%). Post-transplant hypertension occurred in 115 patients (59.5%), DM in 44 patients (22.9%), infections in 99 (51.5%), hepatic complications in 44 (22.9%) and malignancy in 25 patients (13%). Fatal infections in 60 patients (31.3%) were the main causes of death followed by cardiovascular causes in 29 patients (15.2%), liver cell failure in 20 patients (10.7%) and malignancy in 9 patients (4.6%). Mean serum creatinine at last follow up was 2 ± 0.6 mg/dl.Conclusions: DWGF constitutes of 27% of total graft loss. The commonest causes were fatal infections and CVS disease respectively. DWGF develops due to co-morbid medical illness, pre-transplant dialysis and other factors related to transplantation. Understanding different causes of death is mandatory in order to improve the long-term outcomes.