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.

 

Reasons for improved survival

The exact reason (s) of the improved patient’s survival after a kidney transplant still uncertain. However, the following explanations my help unmasking the nature of this benefit:

1]    A well-functioning kidney graft is more physiological resembling the normal human kidney as compared to those maintained on dialysis modality, moreover, survival benefit may be partially attributed to the better removal of uremic toxins.

2]    The recovered kidney function may lower the inflammatory and/or oxidative stress that observed in patients maintained on chronic dialysis. Examples of these elevated mediators are the C-reactive protein, TNF-alpha, and IL6 (interleukin-6).

3]    In patients with diabetes, the recovery of normal kidney function after transplantation may reverse the progress in microvascular morbidity via decreasing the circulating advanced glycosylation end products that accumulate in diabetics with kidney failure and contribute to the evolution of vascular morbidity.  

4]    Furthermore, LVH (left ventricular hypertrophy) may be reversed post-kidney transplant that may limit the risk of death due to coronary artery disease. In addition, decline in the current inflammatory process and oxidative stress that may also contribute in the increased risk of cardiovascular-associated morbidity.

 N.B. This Blogger is created to declare patient longevity after transplantation.