Kidney transplant recipients who die with functioning grafts: Serum creatinine level and cause of death

How to analyze death with function (DWF) in transplant survival statistics has become an important issue. DWF is a predominant cause of late graft loss. We recognize that some deaths may be related to the transplant. However, considering DWF as a graft loss may obscure some analyses. An additional consideration is whether patients who 'die with function' actually had good kidney function or whether their death was related to or hastened by impaired function. To answer this question, we studied the serum creatinine level and cause of death for kidney recipients who died with function. Between January 1, 1985, and December 31, 1994, we did 1932 kidney transplants for 1806 recipients. Of these, 220 died with function. For the 220, we assessed the time posttransplant that death occurred, the serum creatinine level before the terminal event, and the cause of death. The most common causes of death were infection (22%), myocardial infarction (17%), and sudden death (15%). Mean serum creatinine levels were less than 2 mg/100 ml at 1 year before and at the time of death for the vast majority of these recipients. Our findings demonstrate that kidney recipients who die with function have good renal function - additional support for presenting graft survival data both with and without death censored.