The risk factors for treatment-related mortality within first three months after kidney transplantation

Abstract

Mortality at an early stage after kidney transplantation is a disastrous event. Treatment-related mortality (TRM) within 1 or 3 months after kidney transplantation has been rarely reported. We designed a cohort study using the national Korean Network for Organ Sharing database that includes information about kidney recipients between 2002 and 2016. Their demographic, and laboratory data were collected to analyze risk factors of TRM. A total of 19,815 patients who underwent kidney transplantation in any of 40 medical centers were included. The mortality rates 1 month (early TRM) and 3 months (TRM) after transplantation were 1.7% (n = 330) and 4.1% (n = 803), respectively. Based on a multivariate analysis, older age (hazard ratio [HR] = 1.044), deceased donor (HR = 2.210), re-transplantation (HR = 1.675), ABO incompatibility (HR = 1.811), higher glucose (HR = 1.002), and lower albumin (HR = 0.678) were the risk factors for early TRM. Older age (HR = 1.014), deceased donor (HR = 1.642), and hyperglycemia (HR = 1.003) were the common independent risk factors for TRM. In contrast, higher serum glutamic oxaloacetic transaminase (HR = 1.010) was associated with TRM only. The identified risk factors should be considered in patient counselling, and management to prevent TRM. The recipients assigned as the high-risk group require intensive management including glycemic control at the initial stage after transplant.

Fig 1. Cumulative incidence of mortality according to independent factors common to both 1- and 3-month mortality after kidney transplantation.

(A) Total incidence. (B) Older age, (C) Deceased donor, and (D) Hyperglycemia were related to worse outcomes.

Fig 2. Cumulative incidence of mortality according to the factors associated with 1- or 3-month mortality after kidney transplantation.

(A) Re-transplantation correlated with a worse outcome 1 month after transplantation. (B) ABO incompatibility and (C) Lowered albumin were risk factors for 1-month mortality after transplantation. (D) Higher serum glutamic oxaloacetic transaminase (SGOT) level was a predictor of 3-month mortality.