Death with graft function after kidney transplantation: a single-center experience

Area of Science:

• Nephrology
• Transplantation Immunology
• Clinical Medicine

Background:

• Death with graft function (DWGF) significantly contributes to long-term kidney allograft and patient loss.
• Understanding the clinical profile and etiology of DWGF is crucial for improving transplant outcomes.

Purpose of the Study:

• To investigate the clinical characteristics of kidney transplant recipients experiencing death with graft function (DWGF).
• To identify the primary causes of DWGF in kidney allograft recipients.

Main Methods:

• A retrospective analysis of 2137 kidney allograft recipients transplanted between 1973-2016 at Seoul National University Hospital.
• Recipients were categorized into four groups: alive with graft function (AWGF), alive with graft loss (AWGL), DWGF, and death with graft loss (DWGL).

Main Results:

• DWGF accounted for 19.3% of graft loss due to death and 38.6% of all deaths among recipients with graft loss.
• DWGF patients were older, more frequently diabetic, and had higher rates of delayed graft function compared to other groups.
• Infection (40.9%), malignancy (28.4%), and cardiovascular disease (11.4%) were the leading causes of DWGF, with infection-related deaths peaking within the first year post-transplant.

Conclusions:

• DWGF represents a substantial cause of kidney allograft loss in the studied cohort.
• Infection and malignancy are the predominant drivers of DWGF throughout the post-transplantation period.
• Enhanced surveillance for infection and malignancy is recommended to mitigate graft loss.