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