The past decade of kidney transplantation has seen many changes in immunosuppression (IS), donor, and recipient characteristics. This study analyzes the associations between the aforementioned changes and causes of graft loss (COGL). Understanding the causes of graft loss is critical in optimizing intervention strategies to improve renal allograft survival.

Methods: Retrospective review of kidney transplant (KTX) patients in our center from 1999-2012. For ease of comparison and display of data, patients were grouped based on year of transplant: 1999-2001, 2002-04, 2005-07, 2008-10, 2011-12. Baseline characteristics, immunosuppressive agents, and causes of graft loss were compared across groups.

Results: Over the past 12 years, there was significant improvement in 3 and 5 year graft survival, increasing from 75% to 93% and from 61% to 93% respectively (p<0.001). During the same time frame, there was an increase in the utilization of expanded criteria donors, cytolytic induction, and tacrolimus (FK). Concurrently, prevalence of acute rejection (p<0.05) and chronic allograft nephropathy (CAN) is decreasing. Despite better control of HTN and dyslipidemia, cardiovascular disease remains a major cause of death among KTX recipients. Death with functioning graft (DWFG) has remained the most frequent cause of graft loss over the years.

Conclusion: With the introduction of potent IS agents, institution of protocols, and better understanding of post-transplant pathology and infection, 3 and 5 year graft survival has improved tremendously. However, despite better control of traditional cardiovascular risk factors, death from cardiovascular disease continues to increase and remains the predominant contributor to graft loss. Efforts to address cardiovascular disease promptly in the post-transplant setting and to improve access to medical care are crucial in the improvement of kidney allograft and patient survival.

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