Has patient survival following renal transplantation improved in the era of modern immunosuppression?

Renal transplantation (TX) is the treatment of choice in the majority of patients with chronic kidney disease. But, these patients have a high mortality rate with respect to the general population despite new immunosuppression treatments and improved clinical management. This justifies that the excellent results obtained in the short terms do not have a parallel clinical benefit in the long term. This worrying situation is probably due to a high prevalence of cardiovascular conditions and infectious and neoplastic entities amongst this population against a backdrop of immunosuppression treatment. Furthermore, there is interaction between these processes, which share causal factors and common pathogenic mechanisms. Mortality thus increases. Therefore, identifying the causes of death and the risk factors, applying morbidity and mortality predictive models and intervening in causal factors could constitute some of the strategies for improving renal transplantation results in terms of survival. This review analyses some of the evidence conditioning this high mortality rate following TX, as well and the therapeutic and prognostic aspects associated with co-morbidity: 1) Magnitude of the problem and causes of death among sufferers; 2) Identification of mortality risk factors; 3) Therapeutic strategies for decrease post-TX mortality and; 4) Prediction of mortality and ischaemic heart disease.