Journal List > J Korean Soc Transplant > v.25(1) > 1034346

J Korean Soc Transplant. 2011 Mar;25(1):22-30. Korean.
Published online March 31, 2011.
Copyright © 2011 The Korean Society for Transplantation
The Changes of Graft Survival and Causes of Graft Failure after Kidney Transplantation
Eunah Hwang, M.D.,1,3 Mihyun Jang, M.D.,1,3 Chunghwan Kwak, M.D.,1,3 Seungyeup Han, M.D.,1,3 Sungbae Park, M.D.,1,3 Hyunchul Kim, M.D.,1,3 Hyoungtae Kim, M.D.,2,3 and Wonhyun Cho, M.D.2,3
1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
2Department of General Surgery, Keimyung University School of Medicine, Daegu, Korea.
3Kidney Institute, Keimyung University School of Medicine, Daegu, Korea.

Corresponding author (Email: )
Received December 27, 2010; Accepted March 04, 2011.



The incidence of acute rejection has decreased with the introduction of new immunosuppressive agents. However, several studies have shown that allograft survival has not clearly improved over the past few decades.


We reviewed patients who underwent kidney transplantation between 1982 and 2007. We compared the causes of graft loss for three decades: 1982~1990 (period I),1991~2000 (period II), and 2001~2007 (period III), with the clinical characteristics of patients with functioning grafts and patients who lost their allografts.


There were 785 recipients with a mean age of 36.1 years, and 65.2% were male. Graft loss occurred in 329 patients (41.9%), and the most common cause of graft loss was chronic allograft nephropathy (CAN, 52.0%), followed by patient death (17.6%), post-transplant glomerulonephritis (12.8%), and non compliance (7.9%). During the three time periods, 129, 172, and 28 patients lost their grafts, respectively. Five-year graft survival was 61.5%, 78.4%, and 90.8%, respectively, and increased significantly (P<0.000). CAN, as a cause of graft loss, fell from 65.1% (period I) to 32.1% (period III, P<0.000), but patient death increased from 12.4% to 32.1% (P=0.034). A multivariate analysis revealed that significant risk factors for graft loss included an older donor, transplantation at period I, and dual immunosuppression. Use of tacrolimus and mycophenolate mofetil was associated with a significantly reduced risk of graft loss.


Graft survival has increased over the last three decades whereas the proportion of CAN, the most common cause of graft loss, has decreased. Attention to the main causes of graft loss, CAN, and patient death will offer potential improvement in graft survival.

Keywords: Kidney transplantation; Death; Graft survival; Graft rejection; Risk factors; Time factors; Treatment outcome


Fig. 1
Graft survival rates according to period of transplantation by Kaplan-Meier analysis.
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Table 1
Demographic characteristics
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Table 2
Causes of graft failure
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Table 3
Causes of patient's death with functioning graft
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Table 4
Outcomes of the patients according to periods of transplantation
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Table 5
Changes of causes of graft failure according to periods of transplantation
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Table 6
Comparison of demographic characteristics : patients with functioning graft vs. with failed graft
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Table 7
Risk factors for graft failure by binary regression analysis
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