Early Kidney Graft Loss: Etiology and Risk
Background and objective: Successful kidney transplantation is optimal treatment for patients with end-stage renal disease (ESRD). However, early graft loss remains a devastating outcome for patients and health care specialists as a crucial cause of rapid return to dialysis and increased patient mortality. The aim of this study was to investigate the incidence, causes and associated risk factors for early graft loss in 90 days posttransplantation and to conduct a comparative analysis of cases when graft was lost early after transplantation with the ones functioning for more than 90 days.
Methods: This retrospective study was performed at the Hospital of Lithuanian University of Health Sciences between May 2000 and December 2016. Of 375 adult transplantations from deceased kidney donors, 23 (6.1%) experienced early graft loss and 7 (1.9%) died with a functioning graft during 90 days after transplantation.
Results: Significant dissimilarity in the waiting time on dialysis before transplantation (54.78 vs. 31.39 months, P= 0.002), rate of delayed graft function (79.2% vs. 20.7%, P = 0.001), incidence of acute graft rejection (69.6% vs. 6.5%, P = 0.008), and infectious complications (82.6% vs. 45.7%, P = 0.003) were observed in early graft loss and graft survival > 90 days groups. Factors associated with early graft loss were identified: higher donor age (P = 0.040, r = 0.220), recipient duration of dialysis before kidney transplantation (P = 0.002, r = 0.371), delayed graft function (P = 0.001, r = 0.549), acute graft rejection (P = 0.007, r = 0.320) and infectious complications after transplantation (P = 0.003, r = 0.353). The multivariate analysis revealed recipient longer duration of dialysis before transplantation (P = 0.02, OR = 1.017) and a higher rate of infectious complications after transplantation (P = 0.011, OR = 4.386) as significant risk factors for early graft loss.
Conclusions: The incidence of early graft loss in our hospital has been decreasing in recent years. The most common cause of early graft loss in our center was transplant nephrectomy due to infectious complications, followed by acute graft rejection. Older donor age, expanded criteria donor type, waiting time for deceased donor kidney transplantation, delayed graft function, posttransplant infections, and acute rejection are associated with early graft loss.
Correspondence to R. Auglienė Department of Nephrology, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Eivenių 2, 50009, Kaunas, Lithuania E-mail: firstname.lastname@example.org