Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;22(3):710-718.
doi: 10.1007/s10157-017-1503-9. Epub 2017 Nov 20.

Death with graft function after kidney transplantation: a single-center experience

Mi-Yeon Yu  1 , Yong Chul Kim  1 , Jung Pyo Lee  2 , Hajeong Lee  1 , Yon Su Kim  3   4
Affiliations

Death with graft function after kidney transplantation: a single-center experience

Mi-Yeon Yu et al. Clin Exp Nephrol. 2018 Jun.

Abstract

Background: Death with graft function (DWGF) is an important cause of long-term loss of grafts and patients. In this study, we investigated clinical characteristics and causes of DWGF in kidney transplant recipients.

Methods: We recruited kidney allograft recipients who underwent surgery during 1973-2016 at Seoul National University Hospital in Korea (n = 2137). We divided recipients into four groups: alive with graft function (AWGF), alive with graft loss (AWGL), DWGF, and death with graft loss (DWGL).

Results: Among 455 recipients with graft loss, 88 (19.3%) lost graft function due to death. DWGF was responsible for 38.6% of a total of 228 deaths. Recipients with DWGF were older, more often diabetic, and experienced delayed graft function more often compared to patients with AWGF, AWGL, and DWGL. Additionally, they had fewer episodes of acute rejection than AWGF and AWGL patients. The majority of DWGF developed because of infection (40.9%), malignancy (28.4%), and cardiovascular disease (11.4%). Infection-related mortality was highest within the first year after transplantation. Death due to malignancy was lowest within the first year, but increased thereafter.

Conclusions: In our center, DWGF was a significant cause of graft loss. Infection and malignancy were the leading causes of DWGF during the overall post-transplantation period. Therefore, close monitoring for infection and malignancy should be instituted to lessen the burden of graft loss.

Keywords: Death with graft function; Infection; Kidney transplant; Malignancy.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of Seoul National University Hospital (IRB approval number 1608-147-787) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The need for informed consent was waived because of its retrospective design.

Figures

Fig. 1
Fig. 1
Algorithm for eligible patient selection. AWGL alive with graft loss, AWGF alive with graft function, DWGF death with graft function, DWGL death with graft loss
Fig. 2
Fig. 2
Cause of death with graft function within 1 year, 1–5 years, 5–10 years, and 10 years or more after kidney transplantation
Fig. 3
Fig. 3
DWGF according to transplant area (a) proportion of DWGF in total graft loss (b) cause of DWGF (c) causative agents in infection-related DWGF (d) causative organ in malignancy-related DWGF. DWGF death with graft function, PTLD post-transplant lymphoproliferative disease
See this image and copyright information in PMC

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. doi: 10.1056/NEJMra011295. - DOI - PubMed
    1. Matas A, Smith J, Skeans M, Thompson B, Gustafson S, Stewart D, et al. OPTN/SRTR 2013 annual data report: kidney. Am J Transplant. 2015;15:1–34. doi: 10.1111/ajt.13195. - DOI - PubMed
    1. United States Renal Data System, 2014 USRDS Annual Data Report: an overview of the epidemiology of kidney disease in the United States. National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 2014.
    1. Kahwaji J, Bunnapradist S, Hsu J-W, Idroos ML, Dudek R. Cause of death with graft function among renal transplant recipients in an integrated healthcare system. Transplantation. 2011;91:225–230. doi: 10.1097/TP.0b013e3181ff8754. - DOI - PubMed
    1. Tapiawala SN, Tinckam KJ, Cardella CJ, Schiff J, Cattran DC, Cole EH, et al. Delayed graft function and the risk for death with a functioning graft. J Am Soc Nephrol. 2009;21:153–161. doi: 10.1681/ASN.2009040412. - DOI - PMC - PubMed