title: Infectious complications as the leading cause of death after kidney transplantation: analysis of more than 10,000 transplants from a single center.
abstract: OBJECTIVE
  To identify specific causes of graft failure in a large sample of kidney transplant patients from a middle-income, developing country.
  
  
  METHODS
  Retrospective cohort study analyzing all consecutive single kidney transplants (KTs) performed at a single center in Brazil between January 1st 1998 and December 31st 2013. The database closing date was December 31st 2014.
  
  
  RESULTS
  Out of 10,400 KTs, there were 1191 (11.45%) deaths with a functioning graft, 40 cases (0.38%) of primary non-function (PNF) and 1417 cases (13.62%) of graft loss excluding death and PNF as the cause. Infectious complications (404 cases, 34% of all deaths) were the major cause of death. Most deaths due to infection occurred within the first year after transplantation (157 deaths, 38.86%). Immunologic mechanisms, comprising acute rejection and immune-mediated interstitial fibrosis/tubular atrophy (IF/TA), were responsible for 52% of all cases of graft failure not involving recipient death. Half of the losses by acute rejection occurred late after transplantation.
  
  
  CONCLUSIONS
  Contrary to what is observed in developed countries, infectious complications are the main challenge with kidney transplantation in Brazil. Non-adherence to treatment also appears to contribute significantly to long-term kidney graft loss. Strategies for improvement should focus on better compliance and a greater safety profile of immunosuppressive treatment.
authors.affiliation: Hospital do Rim e Hipertensão Universidade Federal de São Paulo, Rua Borges Lagoa, 960, São Paulo, SP, CEP 04038-002, Brazil.
authors.forename: Flávio
authors.initials: F
authors.lastname: de Castro Rodrigues Ferreira
authors.affiliation: Hospital do Rim e Hipertensão Universidade Federal de São Paulo, Rua Borges Lagoa, 960, São Paulo, SP, CEP 04038-002, Brazil. ninacristelli@yahoo.com.br.
authors.forename: Marina Pontello
authors.initials: MP
authors.lastname: Cristelli
authors.affiliation: Hospital do Rim e Hipertensão Universidade Federal de São Paulo, Rua Borges Lagoa, 960, São Paulo, SP, CEP 04038-002, Brazil.
authors.forename: Mayara Ivani
authors.initials: MI
authors.lastname: Paula
authors.affiliation: Hospital do Rim e Hipertensão Universidade Federal de São Paulo, Rua Borges Lagoa, 960, São Paulo, SP, CEP 04038-002, Brazil.
authors.forename: Henrique
authors.initials: H
authors.lastname: Proença
authors.affiliation: Hospital do Rim e Hipertensão Universidade Federal de São Paulo, Rua Borges Lagoa, 960, São Paulo, SP, CEP 04038-002, Brazil.
authors.forename: Claudia Rosso
authors.initials: CR
authors.lastname: Felipe
authors.affiliation: Hospital do Rim e Hipertensão Universidade Federal de São Paulo, Rua Borges Lagoa, 960, São Paulo, SP, CEP 04038-002, Brazil.
authors.forename: Helio
authors.initials: H
authors.lastname: Tedesco-Silva
authors.affiliation: Hospital do Rim e Hipertensão Universidade Federal de São Paulo, Rua Borges Lagoa, 960, São Paulo, SP, CEP 04038-002, Brazil.
authors.forename: José Osmar
authors.initials: JO
authors.lastname: Medina-Pestana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000175:diagnosis / Q000276:immunology / Q000401:mortality*; D016208:Databases, Factual; D003906:Developing Countries; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Acute rejection; Graft loss; Infectious diseases; Kidney transplantation; Patient survival