Underlying Renal Disease With Iincreased Infection Risk is Associated With Inferior Patient Survival

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BackgroundDespite continuous progress in long-term management after kidney transplantation, mean kidney allograft survival remains at a standstill. How much prognostic relevance of the underlying renal disease influences patient and allograft survival remains unknown, especially long-term. We hypothesized that underlying renal diseases with an increased infection risk is associated with inferior patient survival.MethodsWe analyzed 1.181 first time kidney transplant recipients (KTRs) from 1998 to 2015 and the impact of the underlying renal disease on overall patient and allograft survival. The underlying renal diseases were divided into the following categories: autosomal-dominant-polycystic kidney disease (ADPKD), diabetic disease, glomerulonephritis, vasculitis, nephrosclerosis, uropathies and unknown causes. An additional subgroup analysis was performed for 292 KTRs with different glomerular diseases.ResultsCox-regression analysis of our 1.181 KTRs identified the best death-censored patient survival in patients with glomerulonephritis, followed in ranking by uropathies, unknown causes and nephrosclerosis. Renal diseases associated with higher infectious risk such as vasculitis, ADPKD and diabetic disease showed poor patient outcome (p=0.000). The greatest discrepancy between patient and allograft survival was found in the ADPKD subgroup with a good allograft but poor patient survival (p=0.037). In general, primary loss of allograft function was due to patient death.Our subgroup analysis of patients with underlying glomerulonephritis showed the best death-censored patient survival in patients with membrano-proliferative GN followed by IgA, FSGS and SLE, membranous and vasculitis glomerulonephritis (p=0.000) while death-censored allograft survival IgA followed by vasculitis, FSGS, SLE, membranoproliferative and membranous glomerulonephritis (p=0.004).Overall, our data suggests a better outcome in primary than secondary renal glomerular disease with regards to both patient and allograft outcome.ConclusionsThe overall outcome after kidney transplantation is multifactorial. We could however demonstrate a significant impact of the underlying renal disease with an increased infectious risk, such as seen in ADPKD and diabetes, associated with inferior patient survival. This observation should lead to a focus on prevention and infectious control prior and after kidney transplantation and adaptation of immunosuppressive regimens.

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