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Multicenter Study
. 2012 Dec;27 Suppl 4(Suppl 4):iv39-46.
doi: 10.1093/ndt/gfs544.

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

Jose Maria Morales  1 , Roberto Marcén, Domingo del Castillo, Amado Andres, Miguel Gonzalez-Molina, Federico Oppenheimer, Daniel Serón, Salvador Gil-Vernet, Ildefonso Lampreave, Francisco Javier Gainza, Francisco Valdés, Mercedes Cabello, Fernando Anaya, Fernando Escuin, Manuel Arias, Luis Pallardó, Jesus Bustamante
Affiliations
Free PMC article
Multicenter Study

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

Jose Maria Morales et al. Nephrol Dial Transplant. 2012 Dec.
Free PMC article

Abstract

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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Figures

Fig. 1.
Fig. 1.
Five-year graft survival by age group (non-death-censored).
Fig. 2.
Fig. 2.
Five-year graft survival by age group (death-censored).
Fig. 3.
Fig. 3.
Proteinuria at 6 and 60 months and glomerular filtration (modification of diet in renal disease) at 6, 12, 24, 36, 48 and 60 months by age group.
Fig. 4.
Fig. 4.
Five-year patient survival by age group.
See this image and copyright information in PMC

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References

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