Kidney transplant is well-known to be the best therapeutic approach for patients with end stage renal failure in selected cases.
Patient survival after renal transplantation
Kidney transplant is well-known to be the best therapeutic approach for patients with end stage renal failure in selected cases. This modality may confer the
greatest survival benefit in regard to benefits offered by other modalities
This
survival benefit is mostly observed among diabetics, African-American patients
and obese subjects. The beneficial
outcome, however, extends to involve ALL age subgroups in addition to those
recipients receiving borderline or marginal kidney. Nevertheless, this survival
benefit offered by kidney transplant in comparison to dialysis whatever its
modality still characterized by a high mortality rates as compared to the
general population. The survival rate after kidney transplant may be influenced
by several factors that include:
1)
Recipient age,
2)
Source of the graft,
3)
Gender and race,
4)
The magnitude of immunosuppressive burden, and
5)
Current and degree of severity of co-morbid diseases.
Recent reports among kidney transplant recipients observed
that CVS (cardiovascular) disease is currently the leading cause of death among
adults receiving a kidney allograft. Moreover, de novo heart failure is
commonly observed among kidney transplant recipients. Unfortunately, this type
of heart failure is mostly complicated by a poor outcome. However, in renal
transplant recipients with coronary artery disease necessitating
post-transplant interventional procedures, myocardial revascularization may
show immediately and long-term accepted survival and similar outcome to that
with percutaneous as well as surgical procedures.
Impact of diabetes mellitus
Kidney transplant recipients with diabetes mellitus may
show a lesser survival rates as compared to the non-diabetic cohort. A given
explanation for this observation is the wide prevalence of the extrarenal
vascular disease with its wide co-morbidity. Despite this observation, diabetic
renal transplant recipients still have a better survival as compared to those
patients maintained on regular dialysis.
Cause of death
Considering the high rate of the
immunosuppressive burden immediately after kidney transplantation, infection is
usually the first leading cause of death in that period. The overall burden
rather than a particular immunosuppressive agent is usually responsible. By
time, the offending cause of death is currently changeable with age progression
and with intensity of co-morbidities. Certain reports denote that mortalities
became highly related to cardiac (heart) disease, different malignancies, and cerebrovascular
stroke.