Cause of Premature Deaths Among Living-Donor Kidney Transplants: An Outcome Nobody Wants

Background: Kidney transplant offers survival advantage to end stage renal disease patients compared to those remaining on dialysis. Living donor kidney transplant (LDKT) is considered superior to deceased donor kidney transplant offering additional graft and patient survival benefits. Here, we investigate the cause of early deaths within 5 years of a LDKT and the pertinent characteristics of this cohort. Methods: This is a retrospective study of LDKT at the University of Pennsylvania between 1/1/2015 and 11/30/2023. Premature death was defined as deaths within 5 years of LDKT (n=15). Extensive chart reviews were done and cause of deaths were classified. Presence of pre-existing risk factors, use of immunosuppression, and frequency of post-transplant admissions were recorded. Results: Infection was the most common cause of premature death (46.7%, N=7), accounting for deaths in nearly all 5 years post transplant. This was followed by cardiovascular complications (20%, N=3), which occurred with higher frequency within the first 2 years post-transplant. Around 86.7% (N=13) patients died with a functioning graft. There were 10 patients who were hospitalized 5 or more times post transplant before their death. Conclusion: Deaths within the first 5 years of LDKT were most commonly deaths with a functioning graft. Infectious and cardiovascular causes are the leading causes of deaths. Judicious use of immunosuppression and aggressive cardiovascular care is necessary to avoid these premature deaths.1Ethnicity W=White, Non-Hispanic B=Black, Non-Hispanic