Introduction: The causes of recipient death and renal allograft loss are still under evaluated, and there might be several differences according to the era of transplant, and demographic and epidemiological characteristics of each population.
Objectives: To investigate specific causes of recipient death and graft loss among a recent cohort of kidney transplant recipients.
Methods: Between January 1st 2011 and October 31st 2012 there were 6273 kidney transplant recipients at risk of death or graft loss in follow up. Causes of death and graft loss according to the time after kidney transplant during this period were evaluated.
Results: There were 596 renal graft losses. This population consisted of mostly male (63%) and Caucasian (58%) subjects, aged 42 ± 15 years, recipients of first kidney transplant (94%) with deceased donor (62%). 297 (50%) graft losses were due to death with renal function. The 30-day mortality attributed to kidney transplant was 10.5%. Among the 299 graft losses, 6 (2%) were due to primary nonfunction, 161 (54%) interstitial fibrosis/tubular atrophy (IF/TA), 38 (13%) surgical complications, 36 (12%) acute rejection, 30 (10%) glomerular diseases and 28 (9%) due to miscellaneous reasons. IF/TA was associated with immunological phenomena (recurrent rejection) in 103/161 (64%), bacterial pyelonephritis in 13/161 (8%) and poliomavirus nephropathy in 6/161 (4%) of the cases. Acute rejection accounted for 3.9% of graft losses within the first 6 months after transplantation and 6.4% thereafter (p=0.26). Surgical complications occurred mainly in the first month posttransplant (27/38 cases), and were mostly related to arterial or venous thrombosis (33/38 cases). Infectious events accounted for 55% of the cases (162/297) during all evaluated periods, followed by cardiovascular events (47/297, 14%) and cancer (21/297, 7%).
Conclusion: The high mortality from infectious causes, contrary to that reported in other centers, points to the need for better screening and prophylaxis strategies. On the other hand, the contribution of acute rejection to graft loss, and the predominance of immunological phenomena related to atrophy/fibrosis suggest poor adherence to treatment, and identifies possibilities of investigation and intervention that may result in improved kidney transplantation outcomes.
To cite this abstract in AMA style:Cristelli M, Ivani M, Pita F, Ferreira F, Martins S, Aldworth C, Francoso M, Franco M, Tedesco H, Pestana JMedina-. Recipient Death and Graft Loss in Renal Transplantation: The Challenge of Infectious Complications [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/recipient-death-and-graft-loss-in-renal-transplantation-the-challenge-of-infectious-complications/. Accessed April 22, 2021.
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