Death with a functioning graft in kidney transplant recipients.

The percentage of deceased donor kidney transplant recipients who died with a functioning graft (DWF) within one year after transplantation increased by 1% between 1993-1995, while DWF between 2-5 years after transplant has decreased since 1992, after a 3-year of increase (1989-1992). Deaths due to infection or hemorrhage within the first post-transplant year have increased since 1995 and deaths from cardiovascular disease between 2-5 years after transplantation have decreased. Deaths from malignancies among recipients of living donor kidneys increased significantly from 0.5% to 0.7% after 1995. Diabetic recipients (type II) of deceased donor grafts had a higher incidence of DWF (5% in the first year and nearly 10% between 2-5 years) than recipients with other diseases. Among diabetic recipients of living donor kidneys, DWF occurred in 3% during the first year and 7% between 2-5 years. The incidence of DWF increased as the recipients age increased, from less than 1% among recipients under age 18 to more than 10% of patients over age 60. A multivariable analyses of deceased donor transplants identified the donor age (>45), recipient age (46-60, >60), diabetes, CMV status and intermediate PRA as significant risk factors for DWF. After transplantation, DGF and certain immunosuppression regimens at discharge also influenced DWF. The multivariable analysis results for living donor transplants were similar, except that donor factors had no significant effect on DWF.