Background Death with graft function (DWGF) is a common cause of graft loss
. The risks and determinants of DWGF have not been studied in a recent coho
rt of renal transplant recipients. We performed a population-based survival
analysis of U.S. patients with end-stage renal disease (ESRD) transplanted
between 1988 and 1997.
Methods. Registry data were used to evaluate long-term patient survival and
cause-specific risks of DWGF in 86,502 adult (greater than or equal to 18
years) renal transplant recipients.
Results. Out of 18,482 deaths, 38% (N = 7040) were deaths with graft functi
on. This accounts for 42.5% of all graft loss. Patient survival with graft
function was 97, 91, and 86% at 1, 5, and 10 years, respectively. The risk
of DWGF decreased by 67% (RR = 0.33, P < 0.001) between 1988 and 1997. The
adjusted rate of DWGF was 4.6, 0.8, 2.2, and 1.4 deaths per 1000 person-yea
rs for cardiovascular disease, stroke, infections, and malignancy, respecti
vely. The suicide rate was 15.7 versus 9.0 deaths per 100,000 person-years
in the general population (P < 0.001). In multivariate analysis, the follow
ing factors were independently and significantly predictive of DWGF: white
recipient, age at transplantation, ESRD caused by hypertension or diabetes
mellitus, length of pretransplant dialysis, delayed graft function, acute r
ejection, panel reactive antibody >30%, African American donor race, age >4
5 years, and donor death caused by cerebrovascular disease.
Conclusions. Patients with graft function have a high longterm survival. Al
though DWGF is a major cause of graft loss, the risk has declined substanti
ally since 1990. Cardiovascular disease was the predominant reported cause
of DWGF. Other causes vary by post-transplant time period. Attention to ath
erosclerotic risk factors may be the most important challenge to further im
prove the longevity of patients with successful renal transplants.