Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study

BACKGROUND: To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age. METHODS: The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively an...

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Detalles Bibliográficos
Autores principales: Morales, Jose Maria, Marcén, Roberto, del Castillo, Domingo, Andres, Amado, Gonzalez-Molina, Miguel, Oppenheimer, Federico, Serón, Daniel, Gil-Vernet, Salvador, Lampreave, Ildefonso, Gainza, Francisco Javier, Valdés, Francisco, Cabello, Mercedes, Anaya, Fernando, Escuin, Fernando, Arias, Manuel, Pallardó, Luis, Bustamante, Jesus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2012
Materias:
Original Articles
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526982/
https://www.ncbi.nlm.nih.gov/pubmed/23258810
http://dx.doi.org/10.1093/ndt/gfs544
Descripción
Sumario:BACKGROUND: To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age. METHODS: The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000–2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient's age: Group A: <40 years, Group B: 40–60 years and Group C: >60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids. RESULTS: Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40–60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients <40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria >1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups. CONCLUSIONS: Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.

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