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

Nephrol Dial Transplant. 2012 Dec;27 Suppl 4(Suppl 4):iv39-46. doi: 10.1093/ndt/gfs544.


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.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Age Distribution
  • Female
  • Graft Rejection / epidemiology*
  • Humans
  • Kidney Transplantation / mortality*
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Survival Rate
  • Time Factors