Infectious complications as the leading cause of death after kidney transplantation: analysis of more than 10,000 transplants from a single center

Infectious complications as the leading cause of death after kidney transplantation: analysis of more than 10,000 transplants from a single center

Author Rodrigues Ferreira, Flavio de Castro Autor UNIFESP Google Scholar
Cristelli, Marina Pontello Autor UNIFESP Google Scholar
Paula, Mayara Ivani Autor UNIFESP Google Scholar
Proenca, Henrique Autor UNIFESP Google Scholar
Felipe, Claudia Rosso Autor UNIFESP Google Scholar
Tedesco-Silva, Helio Autor UNIFESP Google Scholar
Medina-Pestana, Jose Osmar Autor UNIFESP Google Scholar
Abstract Aim To identify specific causes of graft failure in a large sample of kidney transplant patients from a middle-income, developing country. Methods Retrospective cohort study analyzing all consecutive single kidney transplants (KTs) performed at a single center in Brazil between January 1st 1998 and December 31st 2013. The database closing date was December 31st 2014. Results Out of 10,400 KTs, there were 1191 (11.45%) deaths with a functioning graft, 40 cases (0.38%) of primary non-function (PNF) and 1417 cases (13.62%) of graft loss excluding death and PNF as the cause. Infectious complications (404 cases, 34% of all deaths) were the major cause of death. Most deaths due to infection occurred within the first year after transplantation (157 deaths, 38.86%). Immunologic mechanisms, comprising acute rejection and immune-mediated interstitial fibrosis/tubular atrophy (IF/TA), were responsible for 52% of all cases of graft failure not involving recipient death. Half of the losses by acute rejection occurred late after transplantation. Conclusion Contrary to what is observed in developed countries, infectious complications are the main challenge with kidney transplantation in Brazil. Non-adherence to treatment also appears to contribute significantly to longterm kidney graft loss. Strategies for improvement should focus on better compliance and a greater safety profile of immunosuppressive treatment.
Keywords Kidney transplantation
Patient survival
Graft loss
Infectious diseases
Acute rejection
Language English
Sponsor Novartis
Alexion
Pfizer
Libbs
Sanofi
Roche
Date 2017
Published in Journal Of Nephrology. Heidelberg, v. 30, n. 4, p. 601-606, 2017.
ISSN 1121-8428 (Sherpa/Romeo, impact factor)
Publisher Springer Heidelberg
Extent 601-606
Origin http://dx.doi.org/10.1007/s40620-017-0379-9
Access rights Closed access
Type Article
Web of Science ID WOS:000405407400016
URI http://repositorio.unifesp.br/handle/11600/51505

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