A single center in-depth analysis of death with a functioning kidney graft and reasons for overall graft failure


 
 
 High numbers of unknown classifications and inconsistent methodologies in previous studies make the interpretation of causes leading to graft loss difficult. In addition, data on a holistic view looking at both death with a functioning graft (DWF) and death-censored graft failure (DCGF) are sparse.
 
 
 
 In this single-center study we included 1477 adult kidney transplants performed between 1997 and 2017 of which all 286 DWF until end of observation were analyzed and causes for death assigned. Additionally, the results were compared to the causes of 303 DCGF of the same cohort, to evaluate the impact of causes for overall graft loss.
 
 
 
 The most frequent causes for DWF were cardiovascular disease (CVD) in 30.8%, malignancy in 28.3% and infections in 21%. Only 9.4% of reasons for DWF were unknown. Sudden death occurred in 40% (35/88) of patients classified as DWF due to CVD. Overall graft loss was related to the effect of immunosuppression in 36.2% (infection: 20.9% (123/589); malignancy: 15.3% (90/589)) and CVD in 22.4% (132/589). In 27.4% (161/589) graft failure was associated with under-immunosuppression (Rejection). For infections (60 DWF; 63 DCGF) and CVD (88 DWF; 44 DCGF) a considerable overlap was observed between DWF and DCGF. For patients > 70 years of age at transplantation, medical events accounted for 78% of overall graft losses and only 6.5% were associated with rejection.
 
 
 
 DWF and DCGF share more causes for graft loss than previously reported, and sudden death plays an underestimated role in death with a functioning graft.
