title: Changing pattern of mortality in renal transplant recipients: a single-center, 30-year experience.
abstract: BACKGROUND
  Patient survival among kidney transplant (KTx) recipients has improved remarkably in the past decades. The most common causes of death are cardiovascular disease in the West; in Taiwan, the answer remains uncertain.
  
  
  METHODS
  From 1983 to 2012, KTx patients who underwent transplantation and were followed at our hospital were recruited for the study. For comparison, patients were stratified according to the transplant time as group 1, 1983-1989 (the initial era); group 2, 1990-1998 (the cyclosporine era); and group 3, 1999-2012 (the modern era, in which tacrolimus and mycophenolate mofetil were available).
  
  
  RESULTS
  A total of 520 KTx patients (male:female ratio of 285:235) were performed in our hospital during the study period. A progressive improvement in patient survival rates (P < .0001) was noted among the 3 groups. At a mean follow-up duration of 9.55 ± 8.20 years, 83 recipients had died. Overall, the most common cause of death was infection (44.6%), followed by cardiovascular disease (21.7%), malignancy (12.0%), and hepatic failure (10.8%). Infection was the main cause of death in groups 1 and 2 (44.1% and 52.6%, respectively) but not in Group 3 (18.2%), although this trend did not reach statistical significance. Death owing to cardiovascular diseases became the most common cause of death (27.3%) in the modern era (group 3).
  
  
  CONCLUSIONS
  The pattern of mortality among Taiwanese KTx patients has changed over the past 30 years. Infection is no longer the commonest cause of death.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, the Chung-Shan Medical University, Taichung, Taiwan. Electronic address: khshu@vghtc.gov.tw.
authors.forename: K-H
authors.initials: KH
authors.lastname: Shu
authors.affiliation: Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: H-C
authors.initials: HC
authors.lastname: Ho
authors.affiliation: Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: M-C
authors.initials: MC
authors.lastname: Wen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, the Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Wu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, the Chung-Shan Medical University, Taichung, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Cheng
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: T-M
authors.initials: TM
authors.lastname: Yu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Y-W
authors.initials: YW
authors.lastname: Chuang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: S-T
authors.initials: ST
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: S-F
authors.initials: SF
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Y-C
authors.initials: YC
authors.lastname: Lo
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: S-C
authors.initials: SC
authors.lastname: Weng
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male
chemical_list: D007166:Immunosuppressive Agents