Chronic allograft nephropathy: Causes of death and mortality risk factors - A review of the last decade in Spain

Background. Improved immunosuppressive regimens and management strategies in renal transplantation (RT) have increased patient and graft survival during the last years. The aim of our study was to analyze the causes, risk factors, and evolution of mortality after renal transplantation. Methods. We studied 3365 renal transplant recipients in adults (>18 years) who survived at least 1 year after transplantation in Spain during 1990, 1994, and 1998. The mortality rates and risk factors were analyzed employing single and multivariate Cox regression. Results. The follow-up was shortest (maximum 2.5 years) for recipients transplanted in 1998. When we consider an identical follow-up period (2.5 years) for all patients, we did not observe a statistical difference in patient survival and causes of death in the three analyzed periods. Mortality was higher for men and for patients over 60 years. Cardiovascular diseases (CVD) and neoplasia were the most frequent causes of death. Graft dysfunction, as determined by creatinine level or proteinuria range in the first months, were significant factors associated with a higher risk for cardiovascular and infectious deaths. Conclusions. During the last decade in Spain, patient survival after RT (2.5 years follow-up) has remained stable. Recipient age (>60 years), male gender, and graft dysfunction in the first year were associated with a higher risk of death especially due to CVD.