Incidence of cause-specific mortality after kidney transplantation: a multicenter French cohort study

The incidence and temporal distribution of causes of death after kidney transplantation are insufficiently described in the literature, particularly in the first months after graft failure. We aimed to describe cause-specific mortality across the kidney transplant course in a French multicenter cohort. We included adult recipients of a kidney transplantation performed in 14 university hospitals between 2008 and 2014. We analyzed causes of death with graft function or occurring until 6 months after graft failure, classified as infection-related, cancer-related, cardiovascular disease-related, other causes, or unknown causes. Cause-specific hazard models were used to assess baseline factors associated with each cause. Among 6,935 recipients, 1,324 died during follow-up. The 10-year cumulative incidences of infection-related, cancer-related and cardiovascular disease-related death were respectively 5.5%, 5.0% and 4.5%. Cardiovascular deaths predominated in the earliest post-transplant period, infections during early follow-up, and cancers became increasingly prominent later. The early post-graft failure period was characterized by high mortality and predominance of infection-related deaths. Baseline factors associated with mortality varied across causes of death. Causes of death after transplantation are dominated by three leading affections (infections, cancers and cardiovascular diseases), together accounting for nearly two-thirds of all deaths, with only modest differences in long-term incidence between them.