Cause of Death in Renal Transplant Patients: A Comparison Between Azathioprine and Ciclosporin

Abstract

The results of renal transplantation have improved due to advances in immunosuppression techniques of preservation, and pre- and postoperative treatments; however, both morbidity and mortality remain serious problems. To decrease the morbidity and mortality rates we analyzed the causes of death after renal transplantation in our hospital. Between 1972 and 1999, we performed 364 renal transplantations, 257 of which were living-related and 107, cadaveric. There were 178 patients given azathioprine and 186 given ciclosporin. The survival rate of the patients on ciclosporin therapy was much better than that of those on azathioprine therapy. Of the total 364 renal transplant patients, 59 (16.2%) died, and 28 (47.5%) of these 59 deaths occurred within 1 year after renal transplantation. The causes of death were infection in 19 (32.2%) patients, gastrointestinal diseases in 16 (27.1%), cardiovascular diseases in 11 (18.6%), cerebrovascular diseases in 6 (10.2%), suicide in 3 (5.1%), and other causes in 4 (6.8%). These findings reinforce that early diagnosis and treatment are essential to decrease the morbidity and mortality rates assoiated with renal transplantation.

Effects of Immunosuppressive Drugs on Platelet Aggregation and Soluble P-Selectin Levels in Renal Transplant Patients

“…[2] Immunosuppressive therapy, which is necessary to avoid premature graft loss, increases the tendency to atheroma. Tacrolimus, cyclosporine (to a greater degree than tacrolimus), and corticosteroids have been implicated in post-transplant hypertension.…”

“…[1] However, post-transplant cardiac complications increase the morbidity and mortality rates after renal transplantation. [2] Cardiovascular disease is the leading cause of death in renal transplant patients accounting for 40-55% of all deaths, and the incidence is considerably higher than in the general population. [3] The main contributing factors leading to atheroma include older age, male gender, hyperlipidemia, smoking, obesity, lack of exercise, hyperglycemia, and hyperhomocysteinanemia.…”

“…[1] Immunosuppressive therapy necessary to avoid premature graft loss may also increase the tendency to atheroma. Hypercoagulability is thought to contribute to the development and progression of atherosclerosis [2,5] and is generally attributed to combined abnormalities in platelet and coagulation-dependent hemostasis in transplanted patients. [6,7] Changes in platelet function [8,9] and fundamental classes of coagulation components, including alterations in clotting factors, fibrinogen, and clotting inhibitors, [10] as well as fibrinolytic system abnormalities [11] may play a role in the prothrombotic state observed in renal transplant patients treated with cyclosporine.…”

Adverse Effects of Immunosuppression in Pediatric Solid Organ Transplantation

“…Specific immunosuppressants have been reported to alter the risk for certain types of cancers. Azathioprine is associated with an increased risk of anogenital, lip, and skin cancers, [27] increasing the risk of the latter by 17%. [25] Tacrolimus, on the other hand, has been associated with a 35% decreased risk of skin cancers compared with other immunosuppressants.…”

Kidney transplantation in the elderly

“…CVD has been attributed to be the most common cause of death followed by infection and then malignancy [15,74]. Some studies have, however, reported infections as a major cause of death [75,76]. Older age, being a risk factor for hypertension, diabetes mellitus [77] and coronary artery calcification [78], puts the older recipients at high risk of CVD.…”