Redondo-Pachón Dolores, Calatayud Emma, Buxeda Anna, Pérez-Sáez María José, Arias-Cabrales Carlos, Gimeno Javier, Burballa Carla, Mir Marisa, Llinàs-Mallol Laura, Outon Sara, Pascual Julio, Crespo Marta
Servicio de Nefrología, Hospital del Mar, Barcelona, Spain.
Servicio de Nefrología, Hospital Universitario Doctor Peset, Valencia, Spain.
Nefrologia (Engl Ed). 2023 May-Jun;43(3):316-327. doi: 10.1016/j.nefroe.2023.07.003. Epub 2023 Jul 26.
The improvement of kidney allograft recipient and graft survival showed a decrease over the last 40 years. Long-term graft loss rate remained stable during a 25-year time span. Knowing the changing causes and the risk factors associated with graft loss requires special attention. The present study aimed to assess the causes of graft loss and kidney allograft recipient death. Also, we aimed to compare two different periods (1979-1999 and 2000-2019) to identify changes in the characteristics of the failed allografts and recipient and donors profile.
We performed a single-center cohort study. We included all the kidney transplant recipients at the Hospital del Mar (Barcelona) between May 1979 and December 2019. Graft loss was defined as recipient death with functioning graft and as loss of graft function (return to dialysis or retransplantation). We assessed the causes of graft loss using clinical and histological information. We also analyzed the results of the two different transplant periods (1979-1999 and 2000-2019).
Between 1979 and 2019, 1522 transplants were performed. The median follow-up time was 56 (IQR 8-123) months. During follow-up, 722 (47.5%) grafts were lost: 483 (66.9%) due to graft failure and 239 (33.1%) due to death with functioning graft. The main causes of death were cardiovascular (25.1%), neoplasms (25.1%), and infectious diseases (21.8%). These causes were stable between the two periods of time. Only the unknown cause of death has decreased in the last period. The main cause of graft failure (loss of graft function) was the allograft chronic dysfunction (75%). When histologic information was available, antibody-mediated rejection (ABMR) and interstitial fibrosis/tubular atrophy (IF/TA) were the most frequent specific causes (15.9% and 12.6%). Of the graft failures, 213 (29.5%) were early (<1 year of transplantation). Vascular thrombosis was the main cause of early graft failure in the second period (2000-2019) (46.7%) and T-cell-mediated rejection (TCMR) was the main cause (31.3%) in the first period (1979-1999). The causes of late graft loss were similar between the two periods.
The causes of kidney allograft recipient death are still due to cardiovascular and malignant diseases. Vascular thrombosis has emerged as a frequent cause of early graft loss in the most recent years. The evaluation of the causes of graft loss is necessary to improve kidney transplantation outcomes.
在过去40年中，肾移植受者和移植肾存活率的改善呈下降趋势。在25年的时间跨度内，长期移植肾丢失率保持稳定。了解移植肾丢失的变化原因及相关风险因素需要特别关注。本研究旨在评估移植肾丢失和肾移植受者死亡的原因。此外，我们旨在比较两个不同时期（1979 - 1999年和2000 - 2019年），以确定失败移植肾的特征以及受者和供者情况的变化。
我们进行了一项单中心队列研究。纳入了1979年5月至2019年12月在巴塞罗那海洋医院接受肾移植的所有受者。移植肾丢失定义为移植肾功能正常时受者死亡以及移植肾功能丧失（恢复透析或再次移植）。我们使用临床和组织学信息评估移植肾丢失的原因。我们还分析了两个不同移植时期（1979 - 1999年和2000 - 2019年）的结果。
1979年至2019年期间，共进行了1522例移植手术。中位随访时间为56（四分位间距8 - 123）个月。随访期间，722例（47.5%）移植肾丢失：483例（66.9%）因移植肾衰竭，239例（33.1%）因移植肾功能正常时受者死亡。主要死亡原因是心血管疾病（25.1%）、肿瘤（25.1%）和感染性疾病（21.8%）。这些原因在两个时间段之间保持稳定。仅最近一段时间不明原因死亡有所减少。移植肾衰竭（移植肾功能丧失）的主要原因是移植肾慢性功能障碍（75%）。当有组织学信息时，抗体介导的排斥反应（ABMR）和间质纤维化/肾小管萎缩（IF/TA）是最常见的具体原因（分别为15.9%和12.6%）。在移植肾衰竭中，213例（29.5%）为早期（移植后<1年）。血管血栓形成是第二个时期（2000 - 2019年）早期移植肾衰竭的主要原因（46.7%），而T细胞介导的排斥反应（TCMR）是第一个时期（1979 - 1999年）的主要原因（31.3%）。两个时期晚期移植肾丢失的原因相似。
肾移植受者死亡原因仍为心血管疾病和恶性疾病。近年来，血管血栓形成已成为早期移植肾丢失的常见原因。评估移植肾丢失的原因对于改善肾移植结局是必要的。
