Purpose: Over the several decades, there has been a considerable improvement in the survival of patients who undergo renal transplantation due to newer immunosuppressive agents and development of surgical technique and post-operative management. However, life expectancy beyond 10 years is still considerably less than that in the general population. We studied the causes of patient death after kidney transplantation to determine the major causes of death, to decrease the mortality rate of patient and to increase the graft survival rate.
Methods: From Jan. 1990 to Dec. 2002, 1353 renal transplantation were performed at Asan Medical Center. There had been 63 cases of patient death and we reviewed the causes of death, recipient-donor relationship, immunosuppressive agents, history of rejection and the time of death after transplantation in these patients, retrospectively.
Results: The major causes of patient death were infection (36.5%), cardiovascular disease (14.3%), malignancy (9.5%), hepatic failure (11.1%), miscellaneous (11.1%) and unknown (22.2%). Thirty-nine (61%) of total death occurred in the first year of transplantation and major cause in first year of transplants was infection (46.2%). Of 63 deaths, 35(55.6%) were with graft function and 49 (77.8%) had history of rejection. The patients with brain- death donor had a higher death rate than that of the patients with living donors (3.7% vs 7.8%, P=0.002). The patients who had history of rejection have higher death rate than the patient with no history of rejection (22.6% vs 1.3%, P<0.001).
Conclusion: Active efforts for the prevention of rejection and infection in early phase of transplantation and close surveillance of malignancy and cardiovascular disease in long-term follow up will decrease the death of transplanted patients and increase the graft survival rate.
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