Analysis of cause of death with a functioning graft: a single-center experience.
BACKGROUND
After the introduction of new immunosuppressants, such as tacrolimus and mycophenolate mofetil, we have achieved excellent results for kidney transplantation with a low acute rejection rate. Currently, nonimmunological factors are considered to be the main cause of graft loss for long-term transplant patients. In this study, we analyzed the cause of death with a functioning graft.


METHODS
We performed 1375 cases of living kidney transplantation (LKT) and 219 cases of cadaveric kidney transplantation (CKT) between January 1983 and December 2002. Of these patients, 86 LKT patients and 19 CKT patients died with a functioning graft.


RESULTS
The mean duration of graft function was 4.8 +/- 4.5 years. The incidence of the causes of death were: infection, 24%; stroke, 17%; cardiovascular disease, 16%; malignant disease, 15%; hepatic failure, 11%; gastric ulcer, 4%; and accident/suicide 2%. Five- and 10-year graft survivals for LKT were 80.2 and 62.0%, respectively. The corresponding values for patients (with the exception of the patients who died with a functioning graft) was 83.0% and 66.1%, respectively. The 5- and 10-year graft survival rates for cadaveric kidney transplants were 70.8% and 48.9%, respectively. The corresponding values for patients (with the exception of the patients who died with a functioning graft) were 75.3% and 52.6%, respectively.


CONCLUSIONS
To prevent death with a functioning graft, management of vascular disorders such as stroke and cardiovascular disease, malignant disease, and infectious disease is crucial for kidney transplant patients.
Shimmura
H
H
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. shimmura@kc.twmu.ac.jp
Tanabe
K
K
Tokumoto
T
T
Ishida
H
H
Ishikawa
N
N
Miyamoto
N
N
Shimizu
T
T
Shirakawa
H
H
Setoguchi
K
K
Teraoka
S
S
Toma
H
H
D000328:Adult; D002423:Cause of Death; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality* / Q000502:physiology*; D019520:Living Donors / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data