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

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 

References

  1. 1.
    O’Regan JA, Canney M, Connaughton DM, O’Kelly P, Williams Y, Collier G, deFreitas DG, O’Seaghdha CM, Conlon PJ (2016) Tacrolimus trough-level variability predicts long-term allograft survival following kidney transplantation. J Nephrol 29(2):269–276CrossRefPubMedGoogle Scholar
  2. 2.
    Karim A, Farrugia D, Cheshire J, Mahboob S, Begaj I, Ray D, Sharif A (2014) Recipient age and risk for mortality after kidney transplantation in England. Transplantation 97(8):832–838CrossRefPubMedGoogle Scholar
  3. 3.
    Ma MK, Lim WH, Craig JC, Russ GR, Chapman JR, Wong G (2016) Mortality among younger and older recipients of kidney transplants from expanded criteria donors compared with standard criteria donors. Clin J Am Soc Nephrol 11(1):128–136CrossRefPubMedGoogle Scholar
  4. 4.
    Gondos A, Döhler B, Brenner H, Opelz G (2013) Kidney graft survival in Europe and the United states: strikingly different long-term outcomes. Transplantation 95(2):267–274CrossRefPubMedGoogle Scholar
  5. 5.
    Wang JH, Skeans MA, Israni AK (2016) Current status of kidney transplant outcomes: dying to survive. Adv Chronic Kidney Dis 23(5):281–286CrossRefPubMedGoogle Scholar
  6. 6.
    Meier-Kriesche HU, Schold JD, Srinivas TR, Kaplan B (2004) Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era. Am J Transplant 4(3):378–383CrossRefPubMedGoogle Scholar
  7. 7.
    El-Zoghby ZM, Stegall MD, Lager DJ, Kremers WK, Amer H, Gloor JM, Cosio FG (2009) Identifying specific causes of kidney allograft loss. Am J Transplant 9(3):527–535CrossRefPubMedGoogle Scholar
  8. 8.
    Naesens M, Kuypers DR, De Vusser K, Evenepoel P, Claes K, Bammens B, Meijers B, Sprangers B, Pirenne J, Monbaliu D, Jochmans I, Lerut E (2014) The histology of kidney transplant failure: a long-term follow-up study. Transplantation 98(4):427–435CrossRefPubMedGoogle Scholar
  9. 9.
    United States Renal Data System (2015) http://www.usrds.org. 2015 Annual Data Report. [Online] 2015. [Cited: https://www.usrds.org/adr.aspx]
  10. 10.
    Australia and New Zealand Dialysis and Transplant Registry (2016) ANZDATA Registry. 38th Report, Chap. 8: Transplantation. [Online] 2016. [Cited: http://www.anzdata.org.au/anzdata/AnzdataReport/38thReport/c08_anzdata_transplantation_v2.0_20160128_web.pdf]
  11. 11.
    Gill JS, Tonelli M (2012) Penny wise, pound foolish? Coverage limits on immunosuppression after kidney transplantation. N Engl J Med 366(7):586–589CrossRefPubMedGoogle Scholar
  12. 12.
    Garcia-Garcia G, Jha V (2015) CKD in disadvantaged populations. J Nephrol 28(1):1–5CrossRefPubMedGoogle Scholar
  13. 13.
    Woodward RS, Page TF, Soares R, Schnitzler MA, Lentine KL, Brennan DC (2008) Income-related disparities in kidney transplant graft failures are eliminated by Medicare’s immunosuppression coverage. Am J Transplant 8(12):2636–2646CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Pilmore H, Dent H, Chang S, McDonald SP, Chadban SJ (2010) Reduction in cardiovascular death after kidney transplantation. Transplantation 89(7):851–857CrossRefPubMedGoogle Scholar
  15. 15.
    Marcos LA, Machicado JD (2014) Soil-transmitted helminth infections in South America. Lancet Infect Dis 14(3):183CrossRefPubMedGoogle Scholar
  16. 16.
    Meinerz G, da Silva CK, Goldani JC, Garcia VD, Keitel E (2016) Epidemiology of tuberculosis after kidney transplantation in a developing country. Transpl Infect Dis 18(2):176–182CrossRefPubMedGoogle Scholar
  17. 17.
    Batista MV, Pierrotti LC, Abdala E, Clemente WT, Girão ES, Rosa DR, Ianhez LE, Bonazzi PR, Lima AS, Fernandes PF, Pádua-Neto MV, Bacchella T, Oliveira AP, Viana CF, Ferreira MS, Shikanai-Yasuda MA (2011) Endemic and opportunistic infections in Brazilian solid organ transplant recipients. Trop Med Int Health 16(9):1134–1142CrossRefPubMedGoogle Scholar
  18. 18.
    World Health Organization (2015) Global Health Observatory data repository, MDG Developed region, Latin America and the Caribbean. [Online] 2015. [Cited: http://apps.who.int/gho/data/view.main.RCODMDGLACV?lang=en]
  19. 19.
    Rodrigues CA, Franco MF, Cristelli MP, Pestana JO, Tedesco-Silva H Jr (2014) Clinicopathological characteristics and effect of late acute rejection on renal transplant outcomes. Transplantation 98(8):885–892CrossRefPubMedGoogle Scholar
  20. 20.
    Krisl JC, Alloway RR, Shield AR, Govil A, Mogilishetty G, Cardi M, Diwan T, Abu Jawdeh BG, Girnita A, Witte D, Woodle ES (2015) Acute rejection clinically defined phenotypes correlate with long-term renal allograft survival. Transplantation 99(10):2167–2173CrossRefPubMedGoogle Scholar
  21. 21.
    Evans RW, Applegate WH, Briscoe DM, Cohen DJ, Rorick CC, Murphy BT, Madsen JC (2010) Cost-related immunosuppressive medication nonadherence among kidney transplant recipients. Clin J Am Soc Nephrol 5(12):2323–2328CrossRefPubMedPubMedCentralGoogle Scholar

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

Personalised recommendations