ROCHESTER, Minn. — 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. Only 1 in 4 transplanted kidney losses were caused by organ rejection.

"Immunosuppression medication to prevent rejection is often the focus when caring for patients posttransplant. But this study highlights the increased risk of death from cancer and infection for transplant patients, especially those who are older and have diabetes," says Andrew Bentall, M.B., Ch.B., M.D., a Mayo Clinic nephrologist and the study's co-first author. The study was recently published in Transplantation Direct.

The study, the largest to examine reasons for transplanted kidney loss, involved 5,752 patients who underwent a kidney transplant at Mayo Clinic kidney transplant programs 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%, infection; and 12.6%, 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%, glomerular diseases; and 13.9%, tubular injury.

Researchers uncovered two types of kidney transplant recipients who are at high risk after transplant. The first are younger, nondiabetic 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.

Dr. Bentall says this study makes clear that care providers need to treat these two populations differently to minimize 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 for kidney transplant recipients.

"It is important for these older patients that care providers emphasize 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," he says. "Making those changes could potentially impact the patient's life and kidney outcomes more than immunosuppression therapies."

Other authors are Massini Merzkani, M.D.; Byron Smith, Ph.D.; Xiomara Benavides Lopez, M.D.; Matthew D’Costa, M.D.; Walter Park; Walter Kremers, Ph.D.; Naim Issa, M.D.; Andrew Rule, M.D.; Harini Chakkera, M.D.; Kunam Reddy, M.B.B.S.; Hasan Khamash, M.D.; Hani Wadei, M.D.; Martin Mai, M.D.; Mariam Alexander, M.D.; Hatem Amer, M.D.; Aleksandra Kukla, M.D.; Mireille El Ters, M.D.; Carrie Schinstock, M.D.; Manish Gandhi, M.D.; Raymond Heilman, M.D.; and Mark Stegall, M.D. — all of Mayo Clinic.

This research was supported by the National Institutes of Health.

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Media contact:

• Heather Carlson Kehren, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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