A. Purpose: The short-term outcome after kidney transplantation has improved substantially, and immunological complications rarely lead to early graft loss. However, a small proportion of grafts are still lost during the first posttransplant year. The aim of this study was to characterize in detail all early graft losses in the current era in a large nationwide cohort of kidney transplant recipients.

B. Methods. Altogether 2447 cytotoxic cross-match negative kidney transplantations, of which 71 were simultaneous pancreas-kidney transplantations, were performed in our institution between June 2004 and October 2016. All graft losses (return to dialysis or patient death) occurring during the first posttransplant year were characterized in detail and risk factors for early death or graft failure were analyzed.

C. Results. During the first posttranplant year altogether 109 grafts were lost (67 grafts failed, and 42 patient died) in the study cohort. One-year graft survival was 95% and patient survival 98%. Of the 42 deaths, 6 (14%) occurred during the first posttransplant month, and 16 (38%) during the first three months after transplantation. Of the deaths, 26 (55)% were due to cardiovascular causes, including 20 deaths due to coronary artery disease, 3 due to pulmonary embolism, and 3 due to stroke. Infectious causes of death were identified in 12 (29%) patients: 4 deaths due to influenza, 4 due to bacterial pneumonia, 2 due to invasive mucormycosis, and one due to atypical mycobacterial infection and one due to Staf. Aureus- septicaemia. In addition, 3 (7%) deaths were due to malignancies, and 4 (9%) due to other causes. Of the 67 failed grafts, 14 (21%) were primary nonfunction of unknown reason, 23 (34%) were lost due to venous thrombosis and 6 (9%) due to arterial thrombosis, 10 (15%) due to acute cellular or humoral rejection unresponsive to treatment, 4 (6%) due to recurrence of primary disease, 2 (3%) due to acute thrombotic microangiopathy, and 8 (12%) due to other reasons. In multivariable Cox regression, risk factors for death included diabetes, and longer duration of pretransplant dialysis treatment, whereas risk factors for graft failure included retransplantation, increased level of panel-reactive antibodies, increased cold ischemia time, and increased donor age.

D. Conclusions. A small proportion of grafts are still lost during the early posttransplant period in the current era, but rarely due to immunological reasons. The most common causes of early death after transplantation are cardiovascular and infectious causes.

CITATION INFORMATION: Helanterä I, Lempinen M. Early Failure of Kidney Transplants in the Current Era. Am J Transplant. 2017;17 (suppl 3).

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