The Changes of Graft Survival and Causes of Graft Failure after Kidney Transplantation

Background The incidence of acute rejection has decreased with the introduction of new immunosuppressive agents. However, several studies have shown that allograft survival has not clearly improved over the past few decades. Methods We reviewed patients who underwent kidney transplantation between 1982 and 2007. We compared the causes of graft loss for three decades: 1982∼1990 (period I), 1991∼2000 (period II), and 2001∼2007 (period III), with the clinical characteristics of patients with functioning grafts and patients who lost their allografts. Results There were 785 recipients with a mean age of 36.1 years, and 65.2% were male. Graft loss occurred in 329 patients (41.9%), and the most common cause of graft loss was chronic allograft nephropathy (CAN, 52.0%), followed by patient death (17.6%), post-transplant glomerulonephritis (12.8%), and non compliance (7.9%). During the three time periods, 129, 172, and 28 patients lost their grafts, respectively. Five-year graft survival was 61.5%, 78.4%, and 90.8%, respectively, and increased significantly (P＜0.000). CAN, as a cause of graft loss, fell from 65.1% (period I) to 32.1% (period III, P＜0.000), but patient death increased from 12.4% to 32.1% (P=0.034). A multivariate analysis revealed that significant risk factors for graft loss included an older donor, transplantation at period I, and dual immunosuppression. Use of tacrolimus and mycophenolate mofetil was associated with a significantly reduced risk of graft loss. Conclusions Graft survival has increased over the last three decades whereas the proportion of CAN, the most common cause of graft loss, has decreased. Attention to the main causes of graft loss, CAN, and patient death will offer potential improvement in graft survival.