Evolución de las causas de pérdida del injerto en trasplante renal durante 40 años (1979-2019).
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| Title: | Evolución de las causas de pérdida del injerto en trasplante renal durante 40 años (1979-2019). |
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| Alternate Title: | Evolution of kidney allograft loss causes over 40 years (1979-2019). |
| Authors: | Redondo-Pachón, Dolores1 doloredondop@gmail.com, Calatayud, Emma2, Buxeda, Anna1, José Pérez-Sáez, María1, Arias-Cabrales, Carlos1, Gimeno, Javier3, Burballa, Carla1, Mir, Marisa1, Llinàs-Mallol, Laura1, Outon, Sara1, Pascual, Julio1, Crespo, Marta1 |
| Source: | Nefrologia. May/Jun2023, Vol. 43 Issue 3, p316-327. 12p. |
| Subjects: | KIDNEY transplantation, GRAFT rejection, GRAFT survival, HOMOGRAFTS, TREATMENT effectiveness, BK virus |
| Abstract (English): | Introduction The improvement of kidney allograft recipient and graft survival showed a decrease over the last 40 years. Long-term graft loss rate remained stable during a 25-year time span. Knowing the changing causes and the risk factors associated with graft loss requires special attention. The present study aimed to assess the causes of graft loss and kidney allograft recipient death. Also, we aimed to compare two different periods (1979-1999 and 2000-2019) to identify changes in the characteristics of the failed allografts and recipient and donors profile. Methods and patients We performed a single-center cohort study. We included all the kidney transplant recipients at the Hospital del Mar (Barcelona) between May 1979 and December 2019. Graft loss was defined as recipient death with functioning graft and as loss of graft function (return to dialysis or retransplantation). We assessed the causes of graft loss using clinical and histological information. We also analyzed the results of the two different transplant periods (1979-1999 and 2000-2019). Results Between 1979 and 2019, 1522 transplants were performed. The median follow-up time was 56 (IQR: 8-123) months. During follow-up, 722 (47.5%) grafts were lost: 483 (66.9%) due to graft failure and 239 (33.1%) due to death with functioning graft. The main causes of death were cardiovascular (25.1%), neoplasms (25.1%), and infectious diseases (21.8%). These causes were stable between the two periods of time. Only the unknown cause of death has decreased in the last period. The main cause of graft failure (loss of graft function) was the allograft chronic dysfunction (75%). When histologic information was available, antibody-mediated rejection (ABMR) and interstitial fibrosis/tubular atrophy (IF/TA) were the most frequent specific causes (15.9% and 12.6%). Of the graft failures, 213 (29.5%) were early (<1 year of transplantation). Vascular thrombosis was the main cause of early graft failure in the second period (2000-2019) (46.7%) and T-cell-mediated rejection (TCMR) was the main cause (31.3%) in the first period (1979-1999). The causes of late graft loss were similar between the two periods. Conclusions The causes of kidney allograft recipient death are still due to cardiovascular and malignant diseases. Vascular thrombosis has emerged as a frequent cause of early graft loss in the most recent years. The evaluation of the causes of graft loss is necessary to improve kidney transplantation outcomes. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | Introducción La mejoría en la supervivencia del receptor y del injerto renal sufre un proceso de deceleración. La tasa de pérdida del injerto a medio y largo plazo permanece estable desde hace 25 años. Es fundamental conocer las causas de pérdida del injerto y los factores relacionados, así como identificar si se han producido cambios en las causas de pérdida del injerto en los últimos años. El objetivo del presente estudio fue evaluar las causas de pérdida del injerto según fallecimiento del receptor o pérdida del injerto con vuelta a diálisis/retrasplante, y analizar las causas específicas de pérdida del injerto en 2 épocas (1979-1999 y 2000-2019) para identificar cambios en el perfil de los injertos perdidos. Pacientes y métodos Estudio retrospectivo de todos los trasplantes renales (TR) realizados en el Hospital del Mar (Barcelona) entre mayo-1979 y diciembre-2019. Consideramos pérdida del injerto el fallecimiento del paciente con injerto funcionante o el re-inicio de diálisis o retrasplante. Revisamos las causas de pérdida mediante información clínica e histológica, y analizamos los resultados en 2 periodos (1979-1999 y 2000-2019). Resultados De los 1.522 TR realizados, 722 (47,5%) perdieron el injerto renal con una mediana de seguimiento hasta la pérdida de 56 (RIQ: 8-123) meses. De estas pérdidas, 483 (66,9%) se produjeron por fracaso del injerto y 239 (33,1%) por fallecimiento del receptor con injerto funcionante. Las causas del fallecimiento fueron las cardiovasculares (25,1%), las neoplasias (25,1%) y las infecciones (21,8%), de forma similar en ambas épocas de trasplante. Solo el éxitus de causa desconocida ha disminuido en la época más reciente. La principal causa de vuelta a diálisis/retrasplante fue la disfunción del injerto (75%), siendo el rechazo mediado por anticuerpos y la fibrosis intersticial/atrofia tubular los hallazgos histológicos más frecuentes (15,9 y 12,6%). Del total de pérdidas, 213 fueron precoces (29,5%). La trombosis vascular fue la causa más frecuente de pérdida precoz (< 1 año posTR) entre 2000 y 2019 (46,7%), mientras que en el periodo 1979-1999 lo fue el rechazo celular (31,3%). Las causas de pérdida del injerto tardías fueron similares en ambas épocas. Conclusiones Los pacientes fallecen de causas cardiovasculares y neoplasias, y esto no ha cambiado con los años. La trombosis vascular emerge como causa frecuente de pérdida precoz del injerto en la época actual. La identificación adecuada de las causas de pérdida del injerto es fundamental para mejorar los resultados postrasplante. [ABSTRACT FROM AUTHOR] |
| Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
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| Items | – Name: Title Label: Title Group: Ti Data: Evolución de las causas de pérdida del injerto en trasplante renal durante 40 años (1979-2019). – Name: TitleAlt Label: Alternate Title Group: TiAlt Data: Evolution of kidney allograft loss causes over 40 years (1979-2019). – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Redondo-Pachón%2C+Dolores%22">Redondo-Pachón, Dolores</searchLink><relatesTo>1</relatesTo><i> doloredondop@gmail.com</i><br /><searchLink fieldCode="AR" term="%22Calatayud%2C+Emma%22">Calatayud, Emma</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Buxeda%2C+Anna%22">Buxeda, Anna</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22José+Pérez-Sáez%2C+María%22">José Pérez-Sáez, María</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Arias-Cabrales%2C+Carlos%22">Arias-Cabrales, Carlos</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Gimeno%2C+Javier%22">Gimeno, Javier</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Burballa%2C+Carla%22">Burballa, Carla</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Mir%2C+Marisa%22">Mir, Marisa</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Llinàs-Mallol%2C+Laura%22">Llinàs-Mallol, Laura</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Outon%2C+Sara%22">Outon, Sara</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Pascual%2C+Julio%22">Pascual, Julio</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Crespo%2C+Marta%22">Crespo, Marta</searchLink><relatesTo>1</relatesTo> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Nefrologia%22">Nefrologia</searchLink>. May/Jun2023, Vol. 43 Issue 3, p316-327. 12p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22KIDNEY+transplantation%22">KIDNEY transplantation</searchLink><br /><searchLink fieldCode="DE" term="%22GRAFT+rejection%22">GRAFT rejection</searchLink><br /><searchLink fieldCode="DE" term="%22GRAFT+survival%22">GRAFT survival</searchLink><br /><searchLink fieldCode="DE" term="%22HOMOGRAFTS%22">HOMOGRAFTS</searchLink><br /><searchLink fieldCode="DE" term="%22TREATMENT+effectiveness%22">TREATMENT effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22BK+virus%22">BK virus</searchLink> – Name: Abstract Label: Abstract (English) Group: Ab Data: Introduction The improvement of kidney allograft recipient and graft survival showed a decrease over the last 40 years. Long-term graft loss rate remained stable during a 25-year time span. Knowing the changing causes and the risk factors associated with graft loss requires special attention. The present study aimed to assess the causes of graft loss and kidney allograft recipient death. Also, we aimed to compare two different periods (1979-1999 and 2000-2019) to identify changes in the characteristics of the failed allografts and recipient and donors profile. Methods and patients We performed a single-center cohort study. We included all the kidney transplant recipients at the Hospital del Mar (Barcelona) between May 1979 and December 2019. Graft loss was defined as recipient death with functioning graft and as loss of graft function (return to dialysis or retransplantation). We assessed the causes of graft loss using clinical and histological information. We also analyzed the results of the two different transplant periods (1979-1999 and 2000-2019). Results Between 1979 and 2019, 1522 transplants were performed. The median follow-up time was 56 (IQR: 8-123) months. During follow-up, 722 (47.5%) grafts were lost: 483 (66.9%) due to graft failure and 239 (33.1%) due to death with functioning graft. The main causes of death were cardiovascular (25.1%), neoplasms (25.1%), and infectious diseases (21.8%). These causes were stable between the two periods of time. Only the unknown cause of death has decreased in the last period. The main cause of graft failure (loss of graft function) was the allograft chronic dysfunction (75%). When histologic information was available, antibody-mediated rejection (ABMR) and interstitial fibrosis/tubular atrophy (IF/TA) were the most frequent specific causes (15.9% and 12.6%). Of the graft failures, 213 (29.5%) were early (<1 year of transplantation). Vascular thrombosis was the main cause of early graft failure in the second period (2000-2019) (46.7%) and T-cell-mediated rejection (TCMR) was the main cause (31.3%) in the first period (1979-1999). The causes of late graft loss were similar between the two periods. Conclusions The causes of kidney allograft recipient death are still due to cardiovascular and malignant diseases. Vascular thrombosis has emerged as a frequent cause of early graft loss in the most recent years. The evaluation of the causes of graft loss is necessary to improve kidney transplantation outcomes. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Abstract (Spanish) Group: Ab Data: Introducción La mejoría en la supervivencia del receptor y del injerto renal sufre un proceso de deceleración. La tasa de pérdida del injerto a medio y largo plazo permanece estable desde hace 25 años. Es fundamental conocer las causas de pérdida del injerto y los factores relacionados, así como identificar si se han producido cambios en las causas de pérdida del injerto en los últimos años. El objetivo del presente estudio fue evaluar las causas de pérdida del injerto según fallecimiento del receptor o pérdida del injerto con vuelta a diálisis/retrasplante, y analizar las causas específicas de pérdida del injerto en 2 épocas (1979-1999 y 2000-2019) para identificar cambios en el perfil de los injertos perdidos. Pacientes y métodos Estudio retrospectivo de todos los trasplantes renales (TR) realizados en el Hospital del Mar (Barcelona) entre mayo-1979 y diciembre-2019. Consideramos pérdida del injerto el fallecimiento del paciente con injerto funcionante o el re-inicio de diálisis o retrasplante. Revisamos las causas de pérdida mediante información clínica e histológica, y analizamos los resultados en 2 periodos (1979-1999 y 2000-2019). Resultados De los 1.522 TR realizados, 722 (47,5%) perdieron el injerto renal con una mediana de seguimiento hasta la pérdida de 56 (RIQ: 8-123) meses. De estas pérdidas, 483 (66,9%) se produjeron por fracaso del injerto y 239 (33,1%) por fallecimiento del receptor con injerto funcionante. Las causas del fallecimiento fueron las cardiovasculares (25,1%), las neoplasias (25,1%) y las infecciones (21,8%), de forma similar en ambas épocas de trasplante. Solo el éxitus de causa desconocida ha disminuido en la época más reciente. La principal causa de vuelta a diálisis/retrasplante fue la disfunción del injerto (75%), siendo el rechazo mediado por anticuerpos y la fibrosis intersticial/atrofia tubular los hallazgos histológicos más frecuentes (15,9 y 12,6%). Del total de pérdidas, 213 fueron precoces (29,5%). La trombosis vascular fue la causa más frecuente de pérdida precoz (< 1 año posTR) entre 2000 y 2019 (46,7%), mientras que en el periodo 1979-1999 lo fue el rechazo celular (31,3%). Las causas de pérdida del injerto tardías fueron similares en ambas épocas. Conclusiones Los pacientes fallecen de causas cardiovasculares y neoplasias, y esto no ha cambiado con los años. La trombosis vascular emerge como causa frecuente de pérdida precoz del injerto en la época actual. La identificación adecuada de las causas de pérdida del injerto es fundamental para mejorar los resultados postrasplante. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Nefrologia is the property of Revista Nefrologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1016/j.nefro.2021.12.001 Languages: – Code: spa Text: Spanish PhysicalDescription: Pagination: PageCount: 12 StartPage: 316 Subjects: – SubjectFull: KIDNEY transplantation Type: general – SubjectFull: GRAFT rejection Type: general – SubjectFull: GRAFT survival Type: general – SubjectFull: HOMOGRAFTS Type: general – SubjectFull: TREATMENT effectiveness Type: general – SubjectFull: BK virus Type: general Titles: – TitleFull: Evolución de las causas de pérdida del injerto en trasplante renal durante 40 años (1979-2019). Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Redondo-Pachón, Dolores – PersonEntity: Name: NameFull: Calatayud, Emma – PersonEntity: Name: NameFull: Buxeda, Anna – PersonEntity: Name: NameFull: José Pérez-Sáez, María – PersonEntity: Name: NameFull: Arias-Cabrales, Carlos – PersonEntity: Name: NameFull: Gimeno, Javier – PersonEntity: Name: NameFull: Burballa, Carla – PersonEntity: Name: NameFull: Mir, Marisa – PersonEntity: Name: NameFull: Llinàs-Mallol, Laura – PersonEntity: Name: NameFull: Outon, Sara – PersonEntity: Name: NameFull: Pascual, Julio – PersonEntity: Name: NameFull: Crespo, Marta IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 05 Text: May/Jun2023 Type: published Y: 2023 Identifiers: – Type: issn-print Value: 02116995 Numbering: – Type: volume Value: 43 – Type: issue Value: 3 Titles: – TitleFull: Nefrologia Type: main |
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