Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study

被引:78
作者
Maria Morales, Jose [1 ]
Marcen, Roberto [2 ]
del Castillo, Domingo [3 ]
Andres, Amado [1 ]
Gonzalez-Molina, Miguel [4 ]
Oppenheimer, Federico [5 ]
Seron, Daniel [6 ]
Gil-Vernet, Salvador [7 ]
Lampreave, Ildefonso [8 ]
Javier Gainza, Francisco [8 ]
Valdes, Francisco [9 ]
Cabello, Mercedes [4 ]
Anaya, Fernando [10 ]
Escuin, Fernando [11 ]
Arias, Manuel [12 ]
Pallardo, Luis [13 ]
Bustamante, Jesus [14 ]
机构
[1] Hosp 12 Octubre, Dept Nephrol, E-28041 Madrid, Spain
[2] Hosp Ramon & Cajal, Dept Nephrol, Madrid, Spain
[3] Hosp Reina Sofia, Dept Nephrol, Cordoba, Spain
[4] Hosp Carlos Haya, Dept Nephrol, Malaga, Spain
[5] Hosp Clin Barcelona, Renal Transplant Unit, Barcelona, Spain
[6] Hosp Vall d Hebron, Dept Nephrol, Barcelona, Spain
[7] Bellvitge Hosp, Dept Nephrol, Barcelona, Spain
[8] Hosp Cruces, Dept Nephrol, Baracaldo, Spain
[9] Hosp Juan Canalejo, Dept Nephrol, La Coruna, Spain
[10] Hosp Gen Gregorio Maranon, Dept Nephrol, Madrid, Spain
[11] Hosp La Paz, Dept Nephrol, Madrid, Spain
[12] Hosp Marques de Valdecilla, Dept Nephrol, Santander, Spain
[13] Hosp Dr Peset, Dept Nephrol, Valencia, Spain
[14] Hosp Clin, Dept Nephrol, Valladolid, Spain
关键词
cardiovascular mortality; graft survival; patient survival; renal function; renal transplantation; KIDNEY-TRANSPLANTATION; ALLOGRAFT SURVIVAL; UNITED-STATES; PROTEINURIA; SPAIN; IMPROVEMENT; FAILURE; PATIENT; DISEASE; MARKER;
D O I
10.1093/ndt/gfs544
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
To describe the causes of graft loss, patient death and survival figuresin kidney transplant patients in Spain based on the recipients age. The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 20002002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipients age: Group A: 40 years, Group B: 4060 years and Group C: 60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids. Patients were distributed as follows: 25.85 in Group A (40 years), 50.9 in Group B (4060 years) and 23.19 in Group C (60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7, respectively. Death-censored graft survival was 88, 84.2 and 79.1, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients 40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria 1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups. Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients 40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.
引用
收藏
页码:iv39 / iv46
页数:8
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