Background:
One third of cadaveric kidney transplant recipients suffer graft loss within five years of transplantation. non-immunologic factors that predict mortality among non-transplant patients also may be potentially modifiable risk factors for mortality among patients with transplant failure.
Methods:
Applying multivariate survival analysis to data from the united states renal data system, we determined the effect of immunologic or transplant related factors and non-immunologic factors on mortality in patients who initiated dialysis after kidney transplant failure in the united states between april 1995 and september 1998.
Results:
A total of 4741 patients were followed for a median +/- standard deviation of 15 +/- 11 months after initiation of dialysis after transplant failure. the majority of the 1016 (21%) deaths were due to cardiac (36%) or infectious (17%) causes. patients in the following groups had an increased risk for all-cause mortality: older patients [hazard ratio (hr) = 1.04 per year, 95% confidence interval (95% ci) 1.03-1.04], women (hr = 1.31, 95% ci 1.10-1.56), patients of white race (hr = 1.94, 95% ci 1.32-2.84), patients with diabetes (hr = 1.76, 95% ci 1.43-2.16), peripheral vascular disease (hr = 1.94, 95% ci 1.54-2.43), congestive heart failure (hr = 1.26, 95% ci 1.05-1.53), drug use (hr = 2.23; 95% ci 1.08-4.60), smokers (hr = 1.35, 95% ci 1.01-1.81), first transplant recipients (hr = 1.32, 95% ci 1.02-1.69), and patients with a higher glomerular filtration rate (gfr) at dialysis initiation (hr = 1.04 per ml/min higher, 95% ci 1.02-1.06). those with private insurance (hr = 0.67, 95% ci 0.49-0.93) and higher serum albumin (hr = 0.73 per g/dl higher, 95% ci 0.64-0.83) had a decreased risk for all-cause mortality. acute rejection, antibody induction, donor source, duration of graft survival and the maximum attained gfr during transplantation did not predict all-cause mortality.
Conclusions:
Non-immunologic factors predicted mortality among patients with transplant failure but immunologic and transplant related factors did not. prevention, early diagnosis and treatment of co-morbid conditions and the complications of chronic kidney disease may improve the survival of patients with transplant failure.