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.  https://doi.org/10.4285/jkstn.2011.25.1.22
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: dki@dsmc.or.kr )
Received December 27, 2010; Accepted March 04, 2011.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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

Figures


Fig. 1
Graft survival rates according to period of transplantation by Kaplan-Meier analysis.
Click for larger image

Tables


Table 1
Demographic characteristics
Click for larger image


Table 2
Causes of graft failure
Click for larger image


Table 3
Causes of patient's death with functioning graft
Click for larger image


Table 4
Outcomes of the patients according to periods of transplantation
Click for larger image


Table 5
Changes of causes of graft failure according to periods of transplantation
Click for larger image


Table 6
Comparison of demographic characteristics : patients with functioning graft vs. with failed graft
Click for larger image


Table 7
Risk factors for graft failure by binary regression analysis
Click for larger image

References
1. Pascual M, Theruvath T, Kawai T, Tolkoff-Rubin N, Cosimi AB. Strategies to improve long-term outcomes after renal transplantation. N Engl J Med 2002;346:580–590.
2. Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 2000;342:605–612.
3. Meier-Kriesche HU, Schold JD, Srinivas TR, Kaplan B. Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era. Am J Transplant 2004;4:378–383.
4. Meier-Kriesche HU, Schold JD, Kaplan B. Long-term renal allograft survival: have we made significant progress or is it time to rethink our analytic and therapeutic strategies? Am J Transplant 2004;4:1289–1295.
5. Howard RJ, Patton PR, Reed AI, Hemming AW, van der Werf WJ, Pfaff WW, et al. The changing causes of graft loss and death after kidney transplantation. Transplantation 2002;73:1923–1928.
6. Kim JY, Kim SH, Kim YS, Choi BS, Kim JC, Park SC, et al. Report of 1,500 kidney transplants at the Catholic University of Korea. J Korean Soc Transplant 2006;20:172–180.
7. Rianthavorn P, Ettenger RB. Medication non-adherence in the adolescent renal transplant recipient: a clinician's viewpoint. Pediatr Transplant 2005;9:398–407.
8. Knoll G. Trends in kidney transplantation over the past decade. Drugs 2008;68 Suppl 1:3–10.
9. Cecka JM. The OPTN/UNOS renal transplant registry. Clin Transpl 2004:1–16.
10. Nankivell BJ, Borrows RJ, Fung CL, O'Connell PJ, Allen RD, Chapman JR. The natural history of chronic allograft nephropathy. N Engl J Med 2003;349:2326–2333.
11. Mauiyyedi S, Pelle PD, Saidman S, Collins AB, Pascual M, Tolkoff-Rubin NE, et al. Chronic humoral rejection: identification of antibody-mediated chronic renal allograft rejection by C4d deposits in peritubular pillaries. J Am Soc Nephrol 2001;12:574–582.
12. Jevnikar AM, Mannon RB. Late kidney allograft loss: what we know about it, and what we can do about it. Clin J Am Soc Nephrol 2008;3 Suppl 2:S56–S67.
13. Thaunat O, Legendre C, Morelon E, Kreis H, Mamzer-Bruneel MF. To biopsy or not to biopsy? Should we screen the histology of stable renal grafts. Transplantation 2007;84:671–676.
14. Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int 2000;57:307–313.
15. Evenepoel P, Vanrenterghem Y. Death with functioning graft--a preventable cause of graft loss. Ann Transplant 2001;6:17–20.
16. Sato K, Tadokoro F, Ishida K, Matsuzawa K, Nakayama Y, Yokota K, et al. Causes of death after renal transplantation: a long-term follow-up study. Transplant Proc 1994;26:2017–2018.
17. Washer GF, Schröter GP, Starzl TE, Weil R 3rd. Causes of death after kidney transplantation. JAMA 1983;250:49–54.
18. Hiesse C, Rieu P, Larue JR, Kriaa F, Goupy C, Benoit G, et al. Late graft failure and death in renal transplant recipients: analysis in a single-center population of 1500 patients. Transplant Proc 1997;29:240–242.
19. Lindholm A, Albrechtsen D, Frödin L, Tufveson G, Persson NH, Lundgren G. Ischemic heart disease--major cause of death and graft loss after renal transplantation in Scandinavia. Transplantation 1995;60:451–457.
20. El-Zoghby ZM, Stegall MD, Lager DJ, Kremers WK, Amer H, Gloor JM, et al. Identifying specific causes of kidney allograft loss. Am J Transplant 2009;9:527–535.
21. Nijjar AP, Wang H, Quan H, Khan NA. Ethnic and sex differences in the incidence of hospitalized acute myocardial infarction: British Columbia, Canada 1995-2002. BMC Cardiovasc Disord 2010;10:38.
22. Lim JT, Kim SC, Jang HJ, Moon HK, Han DJ. Cause of death after kidney transplantation. J Korean Soc Transplant 2003;17:157–165.
23. Fairhead T, Knoll G. Recurrent glomerular disease after kidney transplantation. Curr Opin Nephrol Hypertens 2010;19:578–585.
24. Hariharan S, Peddi VR, Savin VJ, Johnson CP, First MR, Roza AM, et al. Recurrent and de novo renal diseases after renal transplantation: a report from the renal allograft disease registry. Am J Kidney Dis 1998;31:928–931.
25. Gourishankar S, Leduc R, Connett J, Cecka JM, Cosio F, Fieberg A, et al. Pathological and clinical characterization of the 'troubled transplant': data from the DeKAF study. Am J Transplant 2010;10:324–330.
26. Han SS, Huh W, Park SK, Ahn C, Han JS, Kim S, et al. Impact of recurrent disease andnephropathy on the long-term allograft outcome in patients with IgA nephropathy. Transpl Int 2010;23:169–175.
27. Brennan DC. Long-term trends in allograft survival. Adv Chronic Kidney Dis 2006;13:11–17.
28. Moreso F, Alonso A, Gentil MA, González-Molina M, Capdevila L, Marcén R, et al. Improvement in late renal allograft survival between 1990 and 2002 in Spain: results from a multicentre casecontrol study. Transpl Int 2010;23:907–913.