[Identifying the specific causes of kidney allograft loss: A population-based study]

Nephrol Ther. 2018 Apr;14 Suppl 1:S39-S50. doi: 10.1016/j.nephro.2018.02.018.
[Article in French]

Abstract

Introduction: Results of kidney transplantation have been improving but long-term allograft survival remains disappointing. The objective of the present study was to identify the specific causes of renal allograft loss, to assess their incidence and long-term outcomes.

Methods: A total of 4783 patients from four French centres, transplanted between January 2004 and January 2014 were prospectively included. A total of 9959 kidney biopsies (protocol and for cause) performed between January 2004 and March 2015 were included. Donor and recipient clinical and biological parameters as well as anti-HLA antibody directed against the donor were included. The main outcome was the long-term kidney allograft survival, including the study of the associated causes of graft loss, the delay of graft loss according to their causes and the determinants of graft loss.

Results: There were 732 graft losses during the follow-up period (median time: 4.51 years) with an identified cause in 95.08 %. Kidney allograft survival at 9 years post-transplant was 78 %. The causes of allograft loss were: antibody-mediated rejection (31.69 %), thrombosis (25.55 %), medical intercurrent disease (14.62 %), recurrence of primary renal disease (7.1 %), BK- or CMV-associated nephropathy (n=35, 4.78 %), T cell-mediated rejection (4.78 %), urological disease (2.46 %) and calcineurin inhibitor nephrotoxicity (1.09 %).

Conclusion: The main causes of allograft loss were antibody-mediated rejection and thrombosis. These results encourage efforts to prevent and detect these complications earlier in order to improve allograft survival.

Keywords: Allograft failure; Antibody-mediated rejection; Dysfonction du greffon; Kidney transplantation; Long-term allograft survival; Rejet médié par les anticorps; Survie du greffon; Transplantation rénale.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Allografts
  • Female
  • France
  • Graft Rejection / epidemiology
  • Graft Rejection / etiology*
  • Graft Survival
  • Humans
  • Incidence
  • Kidney / pathology
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Prospective Studies
  • Survival Analysis
  • Transplantation, Homologous / adverse effects
  • Young Adult