Assessing the Complex Causes of Kidney Allograft Loss

Abstract

BackgroundAlthough graft loss is a primary endpoint in many studies in kidney transplantation and a broad spectrum of risk factors has been identified, the eventual causes of graft failure in individual cases remain ill studied. MethodsWe performed a single-center cohort study in 1000 renal allograft recipients, transplanted between March 2004 and February 2013. ResultsIn total, 365 (36.5%) graft losses were identified, of which 211 (57.8%) were due to recipient death with a functioning graft and 154 (42.2%) to graft failure defined as return to dialysis or retransplantation. The main causes of recipient death were malignancy, infections and cardiovascular disease. The main causes of graft failure were distinct for early failures, where structural issues and primary nonfunction prevailed, compared to later failures with a shift towards chronic injury. In contrast to the main focus of current research efforts, pure alloimmune causes accounted for only 17.5% of graft failures and only 7.4% of overall graft losses, although 72.7% of cases with chronic injury as presumed reason for graft failure had prior rejection episodes, potentially suggesting that allo-immune phenomena contributed to the chronic injury. ConclusionIn conclusion, this study provides better insight in the eventual causes of graft failure, and their relative contribution, highlighting the weight of nonimmune causes. Future efforts aimed to improve outcome after kidney transplantation should align with the relative weight and expected impact of targeting these causes.

Aorto-Iliac Artery Calcification and Graft Outcomes in Kidney Transplant Recipients

“…Death-censored graft failure, as return to dialysis or re-transplantation, is seen in 10–12.5% of kidney transplant recipients at 5–6.2 years after transplantation [ 5 , 6 ]. Overall graft failure, including death with a functioning graft, is seen at a rate of 5% each year of follow-up, of which 40–60% is attributed to death with a functioning graft [ 7 , 8 , 9 , 10 , 11 ]. Graft function decline, as doubling of serum creatinine or graft failure, is seen in 18.8% of kidney transplant recipients at 5.4 years after transplantation [ 12 ].…”

Cox regression analysis of compositional covariates related to death of the kidney transplant-recipient in northeastern Brazil: modeling of covariates associated with renal allograft failure

“…The IP-IMS/RHP-PE maintenance was administered using TAC + MPS + PRED. PRED was administered throughout maintenance at doses of 0.5 mg/kg with maximum dose of 30 mg/day (Van Loon et al, 2020;Wekerle et al, 2017).…”

“…Despite improved graft and patient survival in the first year after KT due to more appropriate clinical control and diagnosis, together with improved treatment of bacterial and viral infections, and rejection, each subsequent year increases the risk of the recipient returning to KRT or evolving to death even with a functioning graft. Long-term CKD-T survival may involve processes linked to malignancy, infections related to immunosuppression, infarction and stroke (Van Loon et al, 2020). The analysis of survival rates and the components of mortality-associated covariates are crucial in the planning and evaluation of CKD-T care (Djamali et al, 2006).…”

The Impact of Different Induction Immunosuppressive Therapy on Long-Term Kidney Transplant Function When Measured by Iothalamate Clearance

“…However, the main challenge is how to improve long-term outcomes [3,4]. The introduction of potent and selective agents for the initiation of immunosuppression, as induction therapy, has reduced the incidence of acute rejection early post transplantation and improved 1-year graft survival [5][6][7][8][9][10][11]. However, long-term graft survival was less linked to induction therapy and more to maintenance immunosuppressive regimen and existence of medical comorbidities.…”