In the past 2 decades by introduction of new immunosuppressive drugs the short-term renal allograft survival has improved substantially due to reduction of acute rejection episodes. The longterm survival has also improved, however, it has been far from satisfactory. The leading causes of late renal allograft loss are: 1- Chronic rejection and 2- Death with functioning graft (DWFG). In studies nearly half of late graft losses have been due to DWFG. In order to improve life expectancy of renal transplant (Tx) recipients, strategies should be adopted either to overcome chronic rejection or to decrease the number of DWFGs. To date, no regimen has been effective in prevention or treatment of chronic rejection; whereas the main causes of DWFG such as infection and cardiovascular disease (CVD), are almost preventable and curable.
It has been shown that recipients of living donor kidneys have much lower incidence of DWFG than deceased donor recipients (22% versus 25% per year). Advancing age among both donors and recipients significantly increases the occurrence of DWFG. Recipients older than age 60 have highest incidence of DWFG. The original kidney disease also affects the incidence of DWFG. In short and long-term follow-ups, recipients with type I and type II diabetes have the highest incidence of DWFG. Some other DWFG related risk factors are: CMV seropositivity, peak PRA (50%-80%), delayed graft function and cyclosporine containing immunosuppressive regimen. In developing countries where infection is the leading cause of DWFG, careful attention for diagnosis and treatment will decrease DWFG. In developed countries, because many older and diabetic patients receive renal Tx; screening for coronary artery disease and its risk factor modifications will decrease DWFG. In one study renal Tx recipients who were treated with Statins had a 24% better survival and those who did not receive treatment.