Journal of Nephrology

, Volume 30, Issue 4, pp 601–606 | Cite as

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

  • Flávio de Castro Rodrigues Ferreira
  • Marina Pontello Cristelli
  • Mayara Ivani Paula
  • Henrique Proença
  • Claudia Rosso Felipe
  • Helio Tedesco-Silva
  • José Osmar Medina-Pestana
Original Article
First Online:
Received:
Accepted:

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 long-term 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 
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Notes

Compliance with ethical standards

Conflict of interest

FCRF: no conflict of interests to declare. MPC: travel grants for Novartis, Alexion, Pfizer, Libbs. Eventual speaker for: Novartis, Alexion, Pfizer, Libbs, Sanofi. MIP: travel grants from Libbs. HP: travel grants from Novartis. CRF: no conflict of interests to declare. HTS: clinical investigation fundings from Novartis, Pfizer, Sanofi, Roche. JOMP: travel grants for Novartis.

Ethical standards and informed consent statements

All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Due to the retrospective nature of this study, formal consent was not required.

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Copyright information

© Italian Society of Nephrology 2017

Authors and Affiliations

  • Flávio de Castro Rodrigues Ferreira
    • 1
  • Marina Pontello Cristelli
    • 1
  • Mayara Ivani Paula
    • 1
  • Henrique Proença
    • 1
  • Claudia Rosso Felipe
    • 1
  • Helio Tedesco-Silva
    • 1
  • José Osmar Medina-Pestana
    • 1
  1. 1.Hospital do Rim e Hipertensão Universidade Federal de São PauloSão PauloBrazil

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