Cancer, infections and heart disease pose the greatest risk to kidney transplant recipients—not organ rejection—according to a recently published Mayo Clinic study. Researchers discovered that recipient death due to factors other than organ rejection is the leading cause for transplanted kidney loss and that only one in four transplanted kidney losses were caused by organ rejection.
Andrew Bentall, a Mayo Clinic nephrologist and the study’s co-first author, said: “Immunosuppression medication to prevent rejection is often the focus when caring for patients post-transplant. But this study highlights the increased risk of death from cancer and infection for transplant patients, especially those who are older and have diabetes.”
The study—recently published in Transplantation Direct—involved 5,752 patients who underwent a kidney transplant at Mayo Clinic kidney transplant programmes in Arizona, Florida or Minnesota between 2006 and 2018.
Of those patients, 691 patients died with a functioning kidney. Researchers found that 20% of these patients died from cancer; 19.7% from infection; and 12.6% from cardiac disease.
Another 553 patients lost their transplant due to the failure of a transplanted kidney. Of these patients, 38.7% of the patients’ kidneys failed due to rejection; 18.6% due to glomerular diseases; and 13.9% due to tubular injury.
Researchers uncovered two types of kidney transplant recipients who are at high risk after transplant. The first are younger, non-diabetic patients who develop kidney failure due to organ rejection. The second group includes older, often diabetic patients who are at risk of death due to causes not associated with organ rejection, including cancer, infections and heart disease.
Bentall said this study makes clear that care providers need to treat these two populations differently to minimise risks. For younger patients, that includes focusing on immunosuppression medication to prevent rejection. For older, often diabetic patients, it is critical to address chronic health issues, such as obesity, high blood pressure and diabetes. Focusing on these lifestyle changes is critical for improving long-term outcomes in kidney transplant recipients, he stated.
“It is important for these older patients that care providers emphasise the need for ongoing lifestyle changes that address obesity, high blood pressure and diabetes. Those include losing weight, exercising and new strategies for managing diabetes,” Bentall added. “Making those changes could potentially impact the patient’s life and kidney outcomes more than immunosuppression therapies.”