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Multicenter Study
. 1999 Oct;230(4):493-8; discussion 498-500.
doi: 10.1097/00000658-199910000-00005.

Decreased acute rejection in kidney transplant recipients is associated with decreased chronic rejection

A J Matas  1 , A Humar, W D Payne, K J Gillingham, D L Dunn, D E Sutherland, J S Najarian
Affiliations
Multicenter Study

Decreased acute rejection in kidney transplant recipients is associated with decreased chronic rejection

A J Matas et al. Ann Surg. 1999 Oct.

Abstract

Objective: To determine whether a recent decrease in the rate of acute rejection after kidney transplantation was associated with a decrease in the rate of chronic rejection.

Summary background data: Single-institution and multicenter retrospective analyses have identified acute rejection episodes as the major risk factor for chronic rejection after kidney transplantation. However, to date, no study has shown that a decrease in the rate of acute rejection leads to a decrease in the rate of chronic rejection.

Methods: The authors studied patient populations who underwent transplants at a single center during two eras (1984-1987 and 1991-1994) to determine the rate of biopsy-proven acute rejection, the rate of biopsy-proven chronic rejection, and the graft half-life.

Results: Recipients who underwent transplantation in era 2 had a decreased rate of biopsy-proven acute rejection compared with era 1 (p < 0.05). This decrease was associated with a decreased rate of biopsy-proven chronic rejection for both cadaver (p = 0.0001) and living donor (p = 0.08) recipients. A trend was observed toward increased graft half-life in era 2 (p = NS).

Conclusions: Development of immunosuppressive protocols that decrease the rate of acute rejection should lower the rate of chronic rejection and improve long-term graft survival.

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Figures

None
Figure 1. Percentage of recipients free of chronic rejection (CR) in era 1 vs. era 2. For both cadaver (A) and living (B) donor recipients, the rate of chronic rejection decreased in era 2.
See this image and copyright information in PMC

References

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    1. Halloran PF, Melk A, Barth C. Rethinking chronic allograft nephropathy: : the concept of accelerated senescence. J Am Soc Nephrol 1999; 10: 167–181. - PubMed

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