Patient survival following renal transplant failure in Canada.

Studies from the United States have shown that renal allograft failure is associated with a high mortality rate. The purpose of this study was to determine whether transplant failure was associated with survival in a recent cohort of kidney transplant recipients with different characteristics and a distinct health care system from the United States. Cox regression was used to model allograft loss as a time-dependent variable with patient survival as the primary outcome in 4743 kidney transplant recipients from the Canadian Organ Replacement Register. During follow-up 607 (12.8%) patients had allograft failure and 411 (8.7%) died. Patients with a functioning transplant had an unadjusted death rate of 2.06 per 100 patient years that increased to 5.14 per 100 patient years following allograft failure. After controlling for important confounding variables, allograft failure was found to increase the risk of death by over threefold compared to patients who maintained transplant function (adjusted hazard ratio, 3.39; 95% CI, 2.75-4.16; p < 0.0001). In conclusion, this analysis has shown that kidney transplant failure is an independent predictor of mortality following renal transplantation in a Canadian population. This finding supports the premise that it is the loss of transplant function, rather than patient or system-related issues, that is the main factor contributing to outcome.