Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study

Jose Maria Morales, Roberto Marcén, Domingo del Castillo, Amado Andres, Miguel Gonzalez-Molina, Federico Oppenheimer, Daniel Serón, Salvador Gil-Vernet, Ildefonso Lampreave, Francisco Javier Gainza, Francisco Valdés, Mercedes Cabello, Fernando Anaya, Fernando Escuin, Manuel Arias, Luis Pallardó, Jesus Bustamante, Jose Maria Morales, Roberto Marcén, Domingo del Castillo, Amado Andres, Miguel Gonzalez-Molina, Federico Oppenheimer, Daniel Serón, Salvador Gil-Vernet, Ildefonso Lampreave, Francisco Javier Gainza, Francisco Valdés, Mercedes Cabello, Fernando Anaya, Fernando Escuin, Manuel Arias, Luis Pallardó, Jesus Bustamante

Abstract

Background: To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age.

Methods: The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000-2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient's age: Group A: <40 years, Group B: 40-60 years and Group C: >60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids.

Results: Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40-60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients <40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria >1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups.

Conclusions: Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.

Figures

Fig. 1.
Fig. 1.
Five-year graft survival by age group (non-death-censored).
Fig. 2.
Fig. 2.
Five-year graft survival by age group (death-censored).
Fig. 3.
Fig. 3.
Proteinuria at 6 and 60 months and glomerular filtration (modification of diet in renal disease) at 6, 12, 24, 36, 48 and 60 months by age group.
Fig. 4.
Fig. 4.
Five-year patient survival by age group.

References

    1. Pascual M, Theruvath T, Kawai T, et al. Strategies to improve long-term outcomes after renal transplantation. N Engl J Med. 2002;346:580.
    1. Woodroffe R, Yao GL, Meads C, et al. Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation. A systematic review and modelling study. Health Technol Assess. 2005;9:1.
    1. Hariharan S, Johnson CP, Bresnahan BA, et al. Improved graft survival after renal transplantation in the United States, 1998 to 1996. N Engl J Med. 2000;342:605.
    1. Meier-Kriesche HU, Schold JD, Srinivas TR, et al. Lack of improvement in renal allograft survival despite a marked decrease of acute rejection rates over the most recent era. Am J Transplant. 2004;4:378.
    1. Foley RN, Parfrey PS, Samak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(Suppl 3):112–119.
    1. Morales JM, Marcen R, Andres A, et al. Renal transplantation in the modern immunosuppressive era in Spain: four-year results from a multicenter database focus on post-transplant cardiovascular disease. Kidney Int. 2008;74(Suppl 111):S94–S99.
    1. Moreso F, Alonso A, Gentil MA, et al. for the Spanish Late Allograft Dysfunction Study Group. Improvement in late real allograft survival between 1990 and 2002 in Spain: results from a multicentre case-control study. Transplant Int. 2010;23:907–913.
    1. Cecka JM. The OPTN/UNOS renal transplant registry. Clin Transpl. 2005:1–16.
    1. Teraoka S, Nomoto K, Kikuchi K, et al. Outcomes of kidney transplants from non-heart-beating deceased donors as reported to the Japan Organ Transplant Network from April 1995–December 2003: a multi-center report. Clin Transpl. 2004:91–102.
    1. Fabrizii V, Kovarik J, Bodingbauer M, et al. Long-term patient and graft survival in the Eurotransplant senior program: a single-center experience. Transplantation. 2005;80:582–9.
    1. Ojo AO, Morales JM, González-Molina M, et al. Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant. 2012 .
    1. Seron D, Arias M, Campistol JM, et al. for the Spanish Chronic Allograft Study Group. Late renal allograft failure between 1990 and 1998 in Spain: a changing scenario. Transplantation. 2003;76:1588–1594.
    1. de Fijter JW, Mallat MJ, Doxiadis II, et al. Increased immunogenicity and cause of graft loss of old donor kidneys. J Am Soc Nephrol. 2001;12:1538.
    1. Morales JM, Dominguez-Gil B. Impact of Tacrolimus and Mycophenolate Mofetil combination on cardiovascular risk profile after kidney transplantation. J Am Soc Nephrol. 2006;17(Suppl 3):s296–s303.
    1. Roodnat JI, Mulder PGH, Van Riemsdijk IC, et al. Ischemia times and donor serum creatinine in relation to renal graft failure. Transplantation. 2003;75:799–804.
    1. Ibis A, Altunoglu A, Akgüll A, et al. Early onset proteinuria after renal transplantation: a marker for allograft dysfunction. Trasplant Proc. 2007;39:938–940.
    1. Sancho A, Gavela E, Avila A, et al. Risk factors and prognosis for proteinuria in renal transplant recipients. Transplant Proc. 2007;39:2145–2147.
    1. Fernandez G, Plaza JJ, Sanchez-Plumed J, et al. Proteinuria: a new marker of long-term graft and patient survival in kidney transplantation. Nephrol Dial Transplant. 2004;19(Suppl 3):47–51.
    1. Yildiz A, Erkoç R, Sever MS, et al. The prognostic importance of severity and type of post-transplant proteinuria. Clin Transpl. 1999;13:241–244.
    1. Cherukuri A, Welberry-Smith MP, Tattersall JE, et al. The clinical significance of early proteinuria after renal transplantation. Transplantation. 2010;89:200–207.
    1. Rayhill SC, D'Alessandro AM, Odorico JS, et al. Simultaneous pancreas–kidney transplantation and living related donor renal transplantation in patients with diabetes: is there a difference in survival? Ann Surg. 2000;231:417–423.
    1. Hariharan S, McBride MA, Cherikh WS, et al. Post-transplant renal function in the first year predicts long-term kidney transplant survival. Kidney Int. 2002;62:311–318.
    1. Vincenti F, Jensik SC, Filo RS, et al. A long-term comparison of tacrolimus (FK506) and cyclosporine in kidney transplantation: evidence for improved allograft survival at five years. Transplantation. 2002;73:775–782.
    1. Kim SJ, Schaubel DE, Fenton SA, et al. Mortality after kidney transplantation: a comparison between the United States and Canada. Am J Transplant. 2006;6:109–114.
    1. Lindholm A, Albrechtsen D, Frodin L, et al. Ischemic heart disease: major cause of death and graft loss alter renal transplantation. Transplantation. 1995;60:451–457.
    1. Briggs D. Causes of death after renal transplantation. Nephrol Dial Transplant. 2001;16:1545–1549.

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