title: Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study.
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.
authors.affiliation: Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain. jmorales@h12o.es
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Morales
authors.forename: Roberto
authors.initials: R
authors.lastname: Marcén
authors.forename: Domingo
authors.initials: D
authors.lastname: del Castillo
authors.forename: Amado
authors.initials: A
authors.lastname: Andres
authors.forename: Miguel
authors.initials: M
authors.lastname: Gonzalez-Molina
authors.forename: Federico
authors.initials: F
authors.lastname: Oppenheimer
authors.forename: Daniel
authors.initials: D
authors.lastname: Serón
authors.forename: Salvador
authors.initials: S
authors.lastname: Gil-Vernet
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Lampreave
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Gainza
authors.forename: Francisco
authors.initials: F
authors.lastname: Valdés
authors.forename: Mercedes
authors.initials: M
authors.lastname: Cabello
authors.forename: Fernando
authors.initials: F
authors.lastname: Anaya
authors.forename: Fernando
authors.initials: F
authors.lastname: Escuin
authors.forename: Manuel
authors.initials: M
authors.lastname: Arias
authors.forename: Luis
authors.initials: L
authors.lastname: Pallardó
authors.forename: Jesus
authors.initials: J
authors.lastname: Bustamante
mesh_terms: D000328:Adult; D017677:Age Distribution; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors