[Causes of death with a functioning graft among kidney allograft recipients].
BACKGROUND
Death with a functioning graft (DWGF) is now one of the main causes of renal transplant (RTx) loss.


OBJECTIVE
To determine whether the causes of DWGF, characteristics of donors and recipients and complications of RTx have changed in the last two decades.


METHODS
Cooperative study of a cohort of 418 kidney grafts performed between 1968 and 2010. Patients were divided into two groups according to whether their kidney transplants were performed between 1968 and 1992 (Group 1) or 1993 and 2010 (Group 2).


RESULTS
Sixty eight patients experienced DWGF. Infections were the leading cause of DWGF in both groups (38 and 41%, respectively), followed by cardiovascular diseases (24 and 23% respectively), gastrointestinal disorders (21 and 26% respectively) and cancer (17 and 10% respectively). There were no significant differences in causes of death between the two groups according to the time elapsed since the renal transplantation. In patients in Group 1, the interval between diagnosis of renal failure and dialysis (HD) and the interval between the start of HD and kidney transplantation were significantly lower than in Group 2. The former had also an increased number of acute rejections in the first five years of kidney transplantation (p < 0.001). In Group 2, patients more often received their kidneys from deceased donors, had previous kidney transplantation, higher rate of antibodies to a panel of lymphocytes and an increased incidence of cardiovascular disorders after five years of RTx.


CONCLUSIONS
The proportion of graft loss due to DWGF has increased over the last 2 decades, but its causes have not changed significantly. Infections are the most common causes of DWGF followed by cardiovascular and digestive diseases.
Sección de Nefrología, Servicio de Medicina Interna, Hospital Naval A Nef, Viña del Mar, Chile. jvegastieb@gmail.com
Jorge
J
Vega
Christian
C
Videla
Hernán
H
Borja
Helmuth
H
Goecke
Felipe
F
Martínez
Pablo
P
Betancour
D000328:Adult; D002423:Cause of Death; D005260:Female; D006084:Graft Rejection / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007668:Kidney / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors