A single centre in-depth analysis of death with a functioning kidney graft and reasons for overall graft failure

Manuel Mayrdorfer; Lutz Liefeldt; Bilgin Osmanodja; Marcel G Naik; Danilo Schmidt; Wiebke Duettmann; Charlotte Hammett; Eva Schrezenmeier; Frank Friedersdorff; Kaiyin Wu; Fabian Halleck; Klemens Budde

doi:10.1093/ndt/gfac327

A single centre in-depth analysis of death with a functioning kidney graft and reasons for overall graft failure

Nephrol Dial Transplant. 2023 Jul 31;38(8):1857-1866. doi: 10.1093/ndt/gfac327.

Authors

Manuel Mayrdorfer^{1

2}, Lutz Liefeldt¹, Bilgin Osmanodja¹, Marcel G Naik^{1

3}, Danilo Schmidt¹, Wiebke Duettmann^{1

3}, Charlotte Hammett¹, Eva Schrezenmeier^{1

3}, Frank Friedersdorff⁴, Kaiyin Wu¹, Fabian Halleck¹, Klemens Budde¹

Affiliations

¹ Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
² Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.
³ Berlin Institute of Health, Berlin, Germany.
⁴ Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

Abstract

Background: High numbers of unknown classifications and inconsistent methodologies in previous studies make the interpretation of causes leading to graft loss difficult. In addition, data on a holistic view looking at both death with a functioning graft (DWFG) and death-censored graft failure (DCGF) are sparse.

Methods: In this single-centre study we included 1477 adult kidney transplants performed between 1997 and 2017, of which all 286 DWFGs until the end of observation were analysed and causes for death assigned. Additionally, the results were compared with the causes of 303 DCGFs of the same cohort to evaluate the impact of causes for overall graft loss.

Results: The most frequent causes for DWFG were cardiovascular disease (CVD) in 30.8%, malignancy in 28.3% and infections in 21%. Only 9.4% of reasons for DWFG were unknown. Sudden death occurred in 40% (35/88) of patients classified as DWFG due to CVD. Overall graft loss was related to the effect of immunosuppression in 36.2% [infection 20.9% (123/589), malignancy 15.3% (90/589)] and CVD in 22.4% (132/589). In 27.4% (161/589), graft failure was associated with underimmunosuppression (rejection). For infections (60 DWFG, 63 DCGF) and CVD (88 DWFG, 44 DCGF), a considerable overlap was observed between DWFG and DCGF. For patients >70 years of age at transplantation, medical events accounted for 78% of overall graft losses and only 6.5% were associated with rejection.

Conclusions: DWFG and DCGF share more causes for graft loss than previously reported and sudden death plays an underestimated role in death with a functioning graft.

Keywords: death with a functioning graft; graft failure; kidney transplantation.

MeSH terms

Adult
Cardiovascular Diseases*
Graft Rejection / etiology
Graft Survival
Humans
Immunosuppression Therapy
Kidney Transplantation* / adverse effects