Renal allograft loss in the first post‐operative month: causes and consequences

Abstract

Early transplant failure is a devastating outcome after kidney transplantation. We report the causes and consequences of deceased donor renal transplant failure in the first 30 d at our center between January 1990 and December 2009. Controls were adult deceased donor transplant patients in the same period with an allograft that functioned >30 d. The incidence of early graft failure in our series of 2381 consecutive deceased donor transplants was 4.6% (n = 109). The causes of failure were allograft thrombosis (n = 48; 44%), acute rejection (n = 19; 17.4%), death with a functioning allograft (n = 17; 15.6%), primary non-function (n = 14;12.8%), and other causes (n = 11; 10.1%). Mean time to allograft failure was 7.3 d. There has been a decreased incidence of all-cause early failure from 7% in 1990 to <1% in 2009. Patients who developed early failure had longer cold ischemia times when compared with patients with allografts lasting >30 d (p < 0.001). Early allograft failure was strongly associated with reduced patient survival (p < 0.001). In conclusion, early renal allograft failure is associated with a survival disadvantage, but has thankfully become less common in recent years.

Association of Early Kidney Allograft Failure with Preformed IgA Antibodies to β 2-Glycoprotein I

“…Vessel thrombosis was the most common cause of early graft loss (44% of total early failures). 27 The findings in the Spanish cohort study that included 2600 patients transplanted in the 2000-2002 period were similar to the findings of our study. The former study found that renal vessel thrombosis, particularly venous thrombosis, was the most frequent cause of graft loss in the first year.…”

“…However, early graft loss still remains a major cause of concern. 27 Although AR is associated with a 1.43-fold increase in graft loss (1.6-fold in DCGS), 28 at present, AR is not the most frequent cause of early graft loss. 29 In a series of 2381 consecutive deceased donor transplants, 4.6% of allografts (109) failed within 30 days of transplantation.…”

“…5 The graft loss described in this work (4.8%) is similar to other previously reported graft loss. 27,29 It is important to note that graft loss was significantly higher in patients with IgA aB2GPI antibodies and that thrombotic events were the primary cause of graft loss. Interestingly, the thrombotic complications (diagnosed using Sidney criteria) were only observed in the group 1 patients.…”

Prevalence, causes, and complications of acute kidney transplant rejection: survey in a single center

“…Previous studies showed that the most common cause of acute graft loss was vascular thrombosis. Acute rejection was the second most common complication that ultimately led to graft loss (7,8). However, in our study, acute renal rejection and vascular thrombosis were the most common, whereas, in similar studies, the primary causes were thrombosis and acute rejection (8).…”

“…In 50% of cases, renal vein thrombosis was the underlying etiology leading to transplant rejection (7). Acute rejection of the transplanted kidney, especially during first weeks after transplantation, imposes irrevocable losses in terms of physical and mental conditions, in addition to economic effects (8). Despite numerous studies of post-transplantation side effects and chronic rejection of the transplanted kidney, few studies have evaluated the relation-ship between acute rejection and early mortality.…”