Death with graft functionamong Egyptian kidney transplant recipients: A single center experience

Background: Death with graft function (DWGF) is an important cause of long-term loss of grafts and patients. In this study, we investigated clinical characteristics and causes of DWGF among kidney transplant recipients in Mansoura from 2002 to 2010. Methods: From January 2002 to December 2010, a total of 800 living donor renal transplants were done in Mansoura. Their data was retrospectively analyzed. Out of 159 reported deaths, 81 patients died with good kidney graft function without need of dialysis. Results: About 27% of graft losses caused by DWGF at mean age of 36 ± 10.7. Males were 59 (72.5%). They reached end stage renal disease (ESKD) secondary to glomerulonephritis in 6, pyelonephritis in 15, polycystic kidney disease in 3 and nephrosclerosis in 5 patients. 52 patients had acute rejections (64.8%). Post-transplant hypertension occurred in 48 patients (59.5%), diabetes mellitus in 18 patients (22.9%), infections in 42 (51.5%), hepatic complications in 19 (22.9%) and malignancy in 11 patients (13.6%). Fatal infections in 25 patients (31.3%) were the main causes of death followed by cardiovascular causes in 12 patients (15.2%), liver cell failure in 9 patients (10.7%) and malignancy in 4 patients (4.6%). Mean serum creatinine at last follow up was 2 ± 0.6 mg/dl. Conclusions: DWGF constitutes of 27% of total graft loss. The commonest cause is fatal infections followed by cardio-vascular illness. DWGF develops due to co-morbid medical illness, pre-transplant dialysis and other factors related to transplantation. Understanding different causes of death is mandatory in order to improve the long-term outcomes.