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Risk factors for graft failure in kidney transplantation

John Vella, MD, FACP, FRCP, FASN
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Albert Q Lam, MD


Despite significant improvements in one-year kidney allograft survival [1], the rate of chronic graft loss after the first year remains substantial and may not have improved over the last decade. As an example, a 2004 study that analyzed first renal transplants performed between 1995 and 2000 found that, despite a reduction in acute rejection rates, there was no improvement over the last 10 years in long-term allograft survival [2]. Despite this, the rate of decline in kidney allograft function appears to have slowed [3], suggesting that improved results relating to long-term allograft survival are possible.

Allograft survival rates also vary among different ethnic groups [4]. This may be explained in part by the presence of a disproportionately higher number of risk factors among certain patient populations and differences in access to health care [5-10].

The following discussion will review the determinants of short-term and long-term graft survival. However, this distinction is to some degree arbitrary since most factors can affect both. As an example, any short-term event that predisposes to episodes of acute rejection will then lead to a greater likelihood of chronic graft loss. In addition, many of these factors influence each other, such as human leukocyte antigen (HLA) mismatching, which may increase the risk of acute renal rejection and subsequent premature allograft failure. A discussion of patient survival after renal transplantation is presented separately. (See "Patient survival after renal transplantation".)


The risk of graft loss has traditionally been divided into an early, high-risk period and a later period of constant low risk [11,12]. A major improvement in renal allograft survival in the past 20 years has been the relative elimination of the early risk period.

A number of factors have been shown to influence short-term graft survival. These include delayed allograft function, human leukocyte antigen (HLA) antibodies, type of donor kidney, donor illness, medical center factors, and other factors.


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Literature review current through: Sep 2016. | This topic last updated: Aug 25, 2016.
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