Late mortality and morbidity five to eighteen years after kidney transplantation

The experience with 102 kidney transplants (86 from cadaver donors) functioning more than 5 years in 99 patients followed in one center is reviewed. With the 100% survival point set at 5 years, patient and graft survivals were 92% and 73% at 10 years, and 70% and 56% at 15 years, respectively. Of those 102 recipients, 58 are presently alive with a functioning graft and 18 died with a functioning graft; 26 patients rejected their graft after a mean interval of 8.3 years posttransplant, 11 of them died within 4-45 months following readmission to dialysis. For the whole group, 29 patients died after a mean period of 10 years following transplantation. Main causes of death were vascular catastrophes (48%), malignancies (21%), sepsis (17%), and liver failure (14%). Because vascular accidents, hepatic failure, and sepsis predominated in male patients, the overall late mortality was higher in male (37%) than in female (25%) patients. The high incidence of late complications--including chronic and acute graft rejections--in long-term kidney recipients constitutes a strong argument for maintaining constant supervision of those patients by a medical team with extensive experience with transplantation.