Different Patterns of Risk Factors for Mortality according Recipient Age after Renal Transplantation. A Multicenter and Prospective Study at Ten Years in the Clinical Practice.
Jose Maria Morales1, Roberto Marcen2, Fernando Anaya3, Amado Andres4, Manuel Arias5, Jesus Bustamante6, Mercedes Cabello7, Domingo Del Castillo8, Fernando Escuin9, Salvador Gil Vernet10, Miguel Gonzalez Molina11, Javier Gainza12, Federico Oppenheimer13, Luis Pallardo14, Daniel Seron15, Francisco Valdes16.
1Research Institute, Hospital 12 de Octubre, Madrid, Spain; 2Nephrology, Hospital Ramon y Cajal, Madrid, Spain; 3Nephrology, Hospital Gregorio Marañón, Madrid, Spain; 4Nephrology, Hospital 12 de Octubre, Madrid, Spain; 5Nephrology, Hospital Marques de Valdecilla, Santander, Spain; 6Nephrology, Hospital Clinico, Valladolid, Spain; 7Nephrology, Hospital Carlos Haya, Malaga, Spain; 8Nephrology, Hospital Reina Sofia, Cordoba, Spain; 9Nephrology, Hospital la Paz, Madrid, Spain; 10Nephrology, Hospital de Bellvitge, Barcelona, Spain; 11Nephrology, Hospital Carlos Haya, Malaga, Spain; 12Nephrology, Hospital de Cruces, Bilbao, Spain; 13Nephrology, Hospital Clinic, Barcelona, Spain; 14Nephrology, Hospital Dr Peset, Valencia, Spain; 15Nephrology, Hospital Vall de Hebron, Barcelona, Spain; 16Nephrology, Hospital Juan Canalejo, La Coruña, Spain
Renal Forum.
The aim of the present study was to define the most important risk factors for mortality after renal transplantation in a population representing the real medicine in the modern immunosuppressive era.
In a multicentric study we included 2592 patients (from 14 hospitals) (Renal Forum Group) who received a renal transplant from deceased donors between 2000-2002 and prospectively followed for 10 years always for the same team. According recipient age, 672 were under forty, 1320 among 40-60 yr and 600 were older than 60 yr. They received steroids, TAC preferently than CyA, and MMF with or without induction (KI 2008). Induction therapy Tymo with steroids, TAC/CyA) and MMF was used in hyperimmunized patients (12.5%).
Patient survival at 10 years was 80.5%, statistical significant different depending recipient age: 95% youngs, 84% middle age and 55% older people. At ten years 80% of patients were maintained with TAC/CyA and 30% were steroids free.
The most frequent causes of mortality were cardiovascular (CDV) , infection and cancer in the three categories. Notably in the group under forty, 30% of deaths were of CDV origin, 19% due to infection and 15% due to cancer.
Risk factors for mortality in the total group were: recipient and donor age, reciepint hepatitis C positive, pretransplant CDV, pretransplant diabetes and delayed graft function. In the multivariate analysis, recipient age is a strong risk factor in all groups, however in young patients pretransplant diabetes, in the middle age pretransplant CDV and in older people serum creatinine at 6mo were the most significant risk factors for mortality.
Censored death graft survival was 72.6% globally, 76%, 71% and 65% in the three categories according recipient age, respectively.
In conclusion, In our current clinical practice 20% of patients died at 10 years posttransplant. Recipient age is a dominant risk factor and notably pretransplant diabetes in young people, pretransplant CDV in middle age and renal function in older people are the most significant factors for mortality.
Astellas, Spain.
