title: Change in mortality risk over time in young kidney transplant recipients.
abstract: Mortality risk for kidney transplant recipients may change with increasing accumulated exposure to the "transplantation milieu." We sought to characterize changes over time in mortality rate and in age-, sex- and race-standardized mortality ratios (SMR) relative to the general population, and to estimate the association between increasing time since first transplant and mortality risk. A total of 18 911 patients who received a first transplant at <21 years old (1983-2006), and whose data were recorded in the USRDS, were studied. There were 2713 deaths over a median follow-up of 8.9 (interquartile range 4.0-14.5; maximum 23) years. Among those with graft function, mortality was highest in the first post transplant year; beyond the first year of the first transplant, age-adjusted mortality rates and SMRs decreased slightly over follow-up. Cause of death was cardiovascular for 34.6%, infection for 19.5%, malignancy for 5.8%, other for 21.4% and unknown for 18.7%. For every 1-year time increment after the end of the first post transplant year, age-adjusted all-cause and cardiovascular mortality rates fell by 1% (p = 0.06) and 16% (p = 0.007), respectively; infection-related mortality rate did not change over time (p = 0.5). These results suggest that exposure to the transplantation milieu has no cumulative negative effects on cardiovascular health over the long term.
authors.affiliation: Department of Pediatrics, Divisions of Nephrology McGill University Faculty of Medicine, Quebec, Canada. beth.foster@muhc.mcgill.ca
authors.forename: B J
authors.initials: BJ
authors.lastname: Foster
authors.forename: M
authors.initials: M
authors.lastname: Dahhou
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.forename: R W
authors.initials: RW
authors.lastname: Platt
authors.forename: J A
authors.initials: JA
authors.lastname: Hanley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007239:Infections / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk