Background: The aim of this study was to analyze the trends in mortality of renal allograft recipients at our centre and if the pattern has changed over the last 30 years.
Methods: We reviewed patients who underwent transplantation and died between 1980 and 2017. We compared the causes of death for three decades: 1980 to 1989, 1990 to 1999, and 2000 to 2017.
Results: Out of 357 kidney transplants followed-up in our center, 90 patients (25.2%). There was 52 male (57.8%) and the mean ages was 52.3 ± 12.4 (range: 58). Basic kidney diseases were, diabetic nephropathy (28.9%) and chronic glomerulonephritis (10.2%). For the three periods, 3, 10, and 77 patients died, respectively. Sepsis mainly due to pneumonia was the main cause of death over the three periods ( 66.7%, 40% and 66.2%, respectively) and cardiovascular diseases accounted for (33.3%, 20% and 27.3%, respectively) with no significant change (P>0.05). Most of these patients died after the first year post transplant with no significant difference (P=0.26), (100%, 60% and 79%, respectively). Death with a functioning graft increased from 33.3% to 60% to 68.8%, respectively with significant difference (p=0.02). We found only by multivariate analysis that mean recipient age (43.2 ±18.1, 60.2 ± 12.2 and 51.9 ± 11.9 years, respectively) (P=0.045), pre-transplant hypertension (0%, 70% and 58.4%, respectively) (P=0.044) and use of induction antibody therapy (33.3%, 40% and 90%, respectively) (P= 0.012) have increase the risk for death over the three decades.  When compared to live kidney transplant recipients during the same study period, we found that those who died exhibited significant differences in recipient's age (median 52 years vs 48 years, P=0.001), hemoglobin at 1-month (median 10.2 vs 11.3 gm%, p= 0.008) and serum creatinine at 1-year (median 111 vs 104 mmol/l, P=0.002).
Conclusion: The causes of graft loss and death have not changed over the last three decades. The main causes of death was infection and cardiac disease.  Death with functioning graft is of concern. Advanced recipient age, early level of hemoglobin, is associated with increased risk for death after kidney transplantation