Causas de muerte en pacientes con un injerto renal funcionante. ¿Han ocurrido cambios en las últimas décadas?

Resumen

CAUSES OF DEATH WITH A FUNCTIONING GRAFT AMONG KIDNEY  ALLOGRAFT RECIPIENTS

Background: Death with a functioning graft (DWGF) is now one of the main causes of renal transplant (RTx) loss. Aim: To determine whether the causes of DWGF, characteristics of donors and recipients and complications of RTx have changed in the last two decades. Subjects and Methods: Cooperative study of a cohort of 418 kidney grafts performed between 1968 and 2010. Patients were divided into two groups according to whether their kidney transplants were performed between 1968 and 1992 (Group 1) or 1993 and 2010 (Group 2). Results: Sixty eight patients experienced DWGF. Infections were the leading cause of DWGF in both groups (38 and 41%, respectively), followed by cardiovascular diseases (24 and 23% respectively), gastrointestinal disorders (21 and 26% respectively) and cancer (17 and 10% respectively). There were no significant differences in causes of death between the two groups according to the time elapsed since the renal transplant. In patients in Group 1, the interval between diagnosis of renal failure and dialysis (HD) and the interval between the start of HD and kidney transplant were significantly lower than in Group 2. The former had also an increased number of acute rejections in the first five years of kidney transplant (p <0.001). In Group 2, patients more often received their kidneys from deceased donors, had previous kidney transplants, higher rate of antibodies to a panel of lymphocytes and an increased incidence of cardiovascular disorders after five years of RTx.  Conclusions: The proportion of graft loss due to DWGF has increased over the last 2 decades, but its causes have not changed significantly. Infections are the most common causes of DWGF followed by cardiovascular and digestive diseases.