Accepted abstract

1. Click to edit Master title style
DEATH WITH GRAFT FUNCTION AMONG EGYPTIAN
KIDNEY TRANSPLANT RECIPIENTS;
Mostafa Gamal
Nephrologist
Urology and Nephrology Center
Mansoura University

2. Introduction
Kidney transplantation is the optimal treatment of
end stage renal disease (ESRD). Despite
improvements in patient selection and
management, every transplant carries risk of graft
loss. 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 a cohort
of 2953 Egyptian kidney transplant recipients.

3. Methods
A total of 291 recipients who died with graft function
(DWGF) were evaluated regarding causes and timing of
death. Causes of death were investigated in different
eras of immunosuppression; era 1 (1976-1995): steroid
and azathioprine, era 2 (1996-2005): cyclosporine-
based and era 3 (2006-2018): tacrolimus-based.
Demographic data, original kidney disease, pre- and
post-transplant co-morbidities, immunosuppression
regimens, biopsy proven acute rejection episodes and
graft function at last follow up were analyzed.

4. Results
•A total of 291 patients (9.9%) died with graft
function. DWGF was responsible for 58.3% of
a total of 499 deaths (figure 1).

5. Figure (1)
• Distribution of patients
according to graft and
patient survival at last
follow up.

6. Results
•Proportion of DWGF in total graft loss had
changed over time. In our retrospective study,
it decreases from 29.5% in era 1 to 13.7% in
the most recent era of kidney transplantation.

7. Results
•Most patients in DWGF group had diabetes
mellitus, hypertension, frequently experienced
more infections and more rejection episodes.
cyclosporine-based immunosuppression was
more prevalent.

8. Results
•For this group of patients, median serum
creatinine at last follow up was 1.7 mg/dl
(range: 0.2 - 7 mg/dl). Out of 291 recipients
who died with functioning graft, 53 patients
(18.2%) died within the first year, 55 (18.9%)
died within 1-5 years, 75 (25.8%) died within
5-10 years while 108 patients (37.1%) died
after 10 years post transplantation.

9. Results
•The majority of DWGF was secondary to
cardio-vascular diseases (CVD) (30.9%) and
serious infections (29.2%) (figure 2).

10. Figure (2)
• Causes of death
among kidney
transplant recipients.

11. Results
•Death due to malignancy was lowest within
the first year (1.9%), increased thereafter but
unexpectedly malignancy (22.2%) was the
third main cause of death in the late period
after transplantation (figure 3).

12. Figure (3)
• Causes of death with
graft function within 1
year, 1-5 years, 5-10
years and >10 years
after kidney
transplantation.

13. Discussion
•DWGF accounts for 24.5% of total graft loss. The
most common cause is cardiovascular disease
followed by serious infections. Pre-transplant
diabetes mellitus, steroid dose and infections had
most significant association with DWGF.
Understanding different causes of death according
to the time after transplantation is mandatory in
order to improve the long-term outcomes.

14. Acknowledgements
• I wish to express my sincere thanks to Prof. DR. Ayman Fathy Refaie, consultant
and chief of Nephrology and dialysis unit, Urology & Nephrology center,
Mansoura University for his kind and valuable supervision.
• I wish to express my deep gratitude to Prof. Dr. Yasser Abdelmoneim Al-Hendy,
Professor of Internal Medicine & Nephrology, Faculty of Medicine, Zagazig
University for his sincere supervision and guidance. His valuable support and
continuous effort were the driving force behind the accomplishment of this
work.
• I am especially grateful to Dr. Ahmed Mohamed Salah Ibrahim, lecturer of Internal
Medicine & Nephrology, Faculty of Medicine, Zagazig University for his kind
supervision and advice.

15. THANK YOU