Background: Death with graft function remains an important cause of graft loss among kidney transplant recipients (KTRs). Little is known about the trend of specific causes of death in KTRs in recent years. Methods: We analyzed United States Renal Data System data (1996–2014) to determine 1- and 10-year all-cause and cause-specific mortality in adult KTRs who died with a functioning allograft. We also studied 1- and 10-year trends in the various causes of mortality. Results: Of 210,327 KTRs who received their first kidney transplant from 1996 to 2014, 3.2% died within 1 year after transplant. Cardiovascular deaths constituted the majority (24.7%), followed by infectious (15.2%) and malignant (2.9%) causes; 40.1% of deaths had no reported cause. Using 1996 as the referent year, all-cause as well as cardiovascular mortality declined, whereas mortality due to malignancy did not. For analyses of 10-year mortality, we studied 94,384 patients who received a first kidney transplant from 1996 to 2005. Of those, 22.1% died over 10 years and the causative patterns of their causes of death were similar to those associated with 1-year mortality. Conclusions: Despite the downtrend in mortality over the last 2 decades, a significant percentage of KTRs die in 10-years with a functioning graft, and cardiovascular mortality remains the leading cause of death. These data also highlight the need for diligent collection of mortality data in KTRs.

Keywords:
Kidney transplant, Cause-specific death, Cardiovascular disease, Malignancy
1.
United States Renal Data System. 2017 USRDS annual data report: Epidemiology of kidney disease in the United States. Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2017.
2.
Hart A, Smith JM, Skeans MA, et al: OPTN/SRTR 2016 annual data report: kidney. Am J Transplant 2018; 18(suppl 1): 18–113.
3.
Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK: Long-term survival in renal transplant recipients with graft function. Kidney Int 2000; 57: 307–313.
4.
Briggs JD: Causes of death after renal transplantation. Nephrol Dial Transplant 2001; 16: 1545–1549.
5.
Howard RJ, Patton PR, Reed AI, et al: The changing causes of graft loss and death after kidney transplantation. Transplantation 2002; 73: 1923–1928.
6.
Brennan DC, Daller JA, Lake KD, Cibrik D, Del Castillo D; Thymoglobulin Induction Study Group: Rabbit antithymocyte globulin versus basiliximab in renal transplantation. N Engl J Med 2006; 355: 1967–1977.
7.
El-Husseini A, Aghil A, Ramirez J, et al: Outcome of kidney transplant in primary, repeat, and kidney-after-nonrenal solid-organ transplantation: 15-year analysis of recent UNOS database. Clin Transplant 2017; 31.
8.
Kahwaji J, Bunnapradist S, Hsu JW, Idroos ML, Dudek R: Cause of death with graft function among renal transplant recipients in an integrated healthcare system. Transplantation 2011; 91: 225–230.
9.
Nichols M, Townsend N, Scarborough P, Rayner M: Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J 2014; 35: 2929.
10.
Ford ES, Ajani UA, Croft JB, et al: Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med 2007; 356: 2388–2398.
11.
Takeda Y, Miyamori I, Wu P, Yoneda T, Furukawa K, Takeda R: Effects of an endothelin receptor antagonist in rats with cyclosporine-induced hypertension. Hypertension 1995; 26(6 pt 1): 932–936.
12.
Textor SC, Canzanello VJ, Taler SJ, et al: Cyclosporine-induced hypertension after transplantation. Mayo Clin Proc 1994; 69: 1182–1193.
13.
Vincenti F, Friman S, Scheuermann E, et al: Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant 2007; 7: 1506–1514.
14.
Heisel O, Heisel R, Balshaw R, Keown P: New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis. Am J Transplant 2004; 4: 583–595.
15.
Opelz G, Dohler B: Association between steroid dosage and death with a functioning graft after kidney transplantation. Am J Transplant 2013; 13: 2096–2105.
16.
Cosio FG, Hickson LJ, Griffin MD, Stegall MD, Kudva Y: Patient survival and cardiovascular risk after kidney transplantation: the challenge of diabetes. Am J Transplant 2008; 8: 593–599.
17.
Hart A, Smith JM, Skeans MA, et al: OPTN/SRTR 2015 annual data report: kidney. Am J Transplant 2017; 17(suppl 1): 21–116.
18.
Trouillhet I, Benito N, Cervera C, et al: Influence of age in renal transplant infections: cases and controls study. Transplantation 2005; 80: 989–992.
19.
Linares L, Cofan F, Cervera C, et al: Infection-related mortality in a large cohort of renal transplant recipients. Transplant Proc 2007; 39: 2225–2227.
20.
Weinrauch LA, D’Elia JA, Weir MR, et al: Infection and malignancy outweigh cardiovascular mortality in kidney transplant recipients: post hoc analysis of the FAVORIT trial. Am J Med 2018; 131: 165–172.
21.
Mazuecos A, Munoz Terol JM, Garcia Alvarez T, et al: Increase in malignancies as cause of death in renal transplant patients. Transplant Proc 2009; 41: 2159–2162.
22.
Pilmore H, Dent H, Chang S, McDonald SP, Chadban SJ: Reduction in cardiovascular death after kidney transplantation. Transplantation 2010; 89: 851–857.
23.
Kiberd BA, Rose C, Gill JS: Cancer mortality in kidney transplantation. Am J Transplant 2009; 9: 1868–1875.
24.
Massie AB, Kucirka LM, Segev DL: Big data in organ transplantation: registries and administrative claims. Am J Transplant 2014; 14: 1723–1730.
25.
Prakash J, Ghosh B, Singh S, Soni A, Rathore SS: Causes of death in renal transplant recipients with functioning allograft. Indian J Nephrol 2012; 22: 264–268.
© 2018 S. Karger AG, Basel
2018
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.