UNLABELLED: Long-term survival in renal transplant recipients with graft function. BACKGROUND: Death with graft function (DWGF) is a common cause of graft loss. The risks and determinants of DWGF have not been studied in a recent cohort of renal transplant recipients. We performed a population-based survival analysis of U.S. patients with end-stage renal disease (ESRD) transplanted between 1988 and 1997. METHODS: Registry data were used to evaluate long-term patient survival and cause-specific risks of DWGF in 86,502 adult (>/=18 years) renal transplant recipients. RESULTS: Out of 18,482 deaths, 38% (N = 7040) were deaths with graft function. This accounts for 42. 5% of all graft loss. Patient survival with graft function was 97, 91, and 86% at 1, 5, and 10 years, respectively. The risk of DWGF decreased by 67% (RR = 0.33, P < 0.001) between 1988 and 1997. The adjusted rate of DWGF was 4.6, 0.8, 2.2, and 1.4 deaths per 1000 person-years for cardiovascular disease, stroke, infections, and malignancy, respectively. The suicide rate was 15.7 versus 9.0 deaths per 100,000 person-years in the general population (P < 0. 001). In multivariate analysis, the following factors were independently and significantly predictive of DWGF: white recipient, age at transplantation, ESRD caused by hypertension or diabetes mellitus, length of pretransplant dialysis, delayed graft function, acute rejection, panel reactive antibody> 30%, African American donor race, age> 45 years, and donor death caused by cerebrovascular disease. CONCLUSIONS: Patients with graft function have a high long-term survival. Although DWGF is a major cause of graft loss, the risk has declined substantially since 1990. Cardiovascular disease was the predominant reported cause of DWGF. Other causes vary by post-transplant time period. Attention to atherosclerotic risk factors may be the most important challenge to further improve the longevity of patients with successful renal transplants.
UNLABELLED: Long-term survival in renal transplant recipients with graft function. BACKGROUND:Death with graft function (DWGF) is a common cause of graft loss. The risks and determinants of DWGF have not been studied in a recent cohort of renal transplant recipients. We performed a population-based survival analysis of U.S. patients with end-stage renal disease (ESRD) transplanted between 1988 and 1997. METHODS: Registry data were used to evaluate long-term patient survival and cause-specific risks of DWGF in 86,502 adult (>/=18 years) renal transplant recipients. RESULTS: Out of 18,482 deaths, 38% (N = 7040) were deaths with graft function. This accounts for 42. 5% of all graft loss. Patient survival with graft function was 97, 91, and 86% at 1, 5, and 10 years, respectively. The risk of DWGF decreased by 67% (RR = 0.33, P < 0.001) between 1988 and 1997. The adjusted rate of DWGF was 4.6, 0.8, 2.2, and 1.4 deaths per 1000 person-years for cardiovascular disease, stroke, infections, and malignancy, respectively. The suicide rate was 15.7 versus 9.0 deaths per 100,000 person-years in the general population (P < 0. 001). In multivariate analysis, the following factors were independently and significantly predictive of DWGF: white recipient, age at transplantation, ESRD caused by hypertension or diabetes mellitus, length of pretransplant dialysis, delayed graft function, acute rejection, panel reactive antibody> 30%, African American donor race, age> 45 years, and donordeath caused by cerebrovascular disease. CONCLUSIONS:Patients with graft function have a high long-term survival. Although DWGF is a major cause of graft loss, the risk has declined substantially since 1990. Cardiovascular disease was the predominant reported cause of DWGF. Other causes vary by post-transplant time period. Attention to atherosclerotic risk factors may be the most important challenge to further improve the longevity of patients with successful renal transplants.
Authors: Jagbir Gill; Marcelo Sampaio; John S Gill; James Dong; Hung-Tien Kuo; Gabriel M Danovitch; Suphamai Bunnapradist Journal: Clin J Am Soc Nephrol Date: 2011-04-21 Impact factor: 8.237
Authors: Greg Knoll; Sandra Cockfield; Tom Blydt-Hansen; Dana Baran; Bryce Kiberd; David Landsberg; David Rush; Edward Cole Journal: CMAJ Date: 2005-11-08 Impact factor: 8.262