Which primary diagnosis has the highest in-hospital mortality rate for kidney recipients?

OBJECTIVES: Although "in-hospital mortality" for several post-renal transplantation complications has been reported in various studies, there is no single published single-center study that compares their hospital mortality rates. We sought to rank the primary diagnoses post-renal transplantation by means of in-hospital mortality. METHODS: We selected 404 consecutive rehospitalizations following kidney transplantation from 2003 to 2005. The causes of rehospitalization were categorized into infection, allograft rejection, surgical complication, cerebrovascular accidents (CVA), malignancy, medication complications, and miscellaneous. Fatality was defined as the relative frequency of death due to the same cause among all admissions. RESULTS: The mortality rate (MR) was 5.7%. From the 23 cases of death, 17 (74%) had a functioning kidney at the time of death. The MR was 40% for CVA, 14.3% for surgical complications, 11.1% for miscellaneous, 5.3% for drug complications, 7% for infections, and 4.8% for graft rejection (P=.002). No death was observed among cases with a diagnosis of malignancy or nephrolithiasis. Inpatient mortality was higher among those with more than one diagnosis at admission: 42.9% for more than two diagnosis, 7.1% for those with two diagnosis, and 4.2% for those with one diagnosis (P=.001). CONCLUSIONS: The in-patient mortality ranking is totally different from the ranking of causes of death in renal recipients. In other words, infection is the leading cause of death due to high incidence, and not high fatality. More rare complications, including CVA and surgical complications, are more often fatal.

Medical comorbidities after renal transplantation.

BACKGROUND: Despite the amount of evidence regarding the negative impact of medical comorbidities after transplantation, little attention has been directly paid to the pattern of somatic comorbidities in renal transplant recipients. The aim of this study was to assess the prevalence of medical comorbidities after kidney transplantation. METHODS: In a cross-sectional study during 2006, we evaluated 119 kidney transplant recipients for somatic comorbidities by using the Ifudu comorbidity index, which evaluated the presence of 14 chronic illnesses among patients undergoing maintenance hemodialysis. Correlations of the Ifudu score with demographic and clinical data were also studied. RESULTS: Eighty-three (90.4%) subjects had at least one medical comorbidity. The mean comorbidity score was 5.17 +/- 4.50. The most frequent comorbidities were nonischemic heart diseases including hypertension (n=75; 63%), visual disturbances (n=42; 35.2%), low back pain and spine and joint disorders (n=30; 25.21%), and musculoskeletal disorders (n=28; 23.5%). A higher comorbidity score was significantly correlated with lower economic status (P<.05), but not with age, gender, marital status, educational level, cause, or duration of end-stage renal disease. CONCLUSION: The prevalence of medical comorbidities among kidney transplant recipients seems to be high, with the highest prevalence due to nonischemic heart diseases, visual disturbances, and musculoskeletal disorders. This highlighted the necessity of providing posttransplant care by a multidisciplinary team of specialists.