Five preventable causes of kidney graft loss in the 1990s: a single-center analysis.
BACKGROUND
Despite improvements in immunosuppressive protocols and patient care, kidney allografts continue to fail. We studied causes of graft loss for primary kidney transplants in the 1990s to determine major causes and potential interventions.


METHODS
Causes of graft loss were reviewed for 1467 primary kidney transplants done at our institution between January 1, 1990, and December 31, 1999. Graft loss for that entire population was studied and then the causes of loss selectively examined at <1 year, 1 to 5 years, and>5 years post-transplant. Finally, causes of loss in the 1990s versus the 1980s were compared.


RESULTS
Five major causes of graft loss were noted in the 1990s: thrombosis, acute rejection (either alone or combined with delayed graft function or infection), chronic rejection, death with function, and noncompliance. In the first year post-transplant, thrombosis (25%) and death with function (41%) were the major causes of graft loss. After the first year, chronic rejection and death with function predominated. For recipients dying with graft function, cardiovascular disease was the major cause of death.


CONCLUSIONS
This study identified the five major causes of kidney graft loss in the 1990s. Different interventions are required to decrease loss from each of these causes. Future research needs to be directed at such interventions.
Matas
Arthur J
AJ
Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA. matas001@umn.edu
Humar
Abhinav
A
Gillingham
Kristen J
KJ
Payne
William D
WD
Gruessner
Rainer W G
RW
Kandaswamy
Raja
R
Dunn
David L
DL
Najarian
John S
JS
Sutherland
David E R
DE
D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery; D016030:Kidney Transplantation; D013927:Thrombosis / Q000150:complications / Q000401:mortality; D016312:Treatment Refusal