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Impact of acute rejection and early allograft function on renal allograft survival.
Transplantation. 1997 Jun 15; 63(11):1611-5.T

Abstract

Both acute rejection and the function of a renal allograft early after transplantation correlate with long-term graft survival. In this study we assessed the relationship between these two factors in 843 adult recipients of first cadaveric renal grafts, transplanted at a single institution and followed for a minimum of 3.5 years. Patients were divided into four groups according to (1) history of acute rejection (AR) during the first 6 months after transplantation, and (2) concentration of serum creatinine at 6 months after transplantation (SCr(6mo) < or > or = 2 mg/dl). Death censored allograft survival was not significantly different among patients without AR and with low SCr(6mo) (group 1, n=376), patients without AR but with an elevated SCr(6mo) (group 2, n=117), and patients with AR but low SCr(6mo) (group 3, n=185). In contrast, graft survival was significantly worse in patients with AR and an elevated SCr(6mo) (group 4, n=165) compared with patients in the other three groups (Cox, P<0.0001). The elevated SCr(6mo) in group 4 patients was not necessarily the consequence of AR, as 32% of patients in group 4 had a SCr at 10 days after transplantation (SCr(10d)), before they had AR, that was equal to or higher than the SCr(6mo). Based on this observation we investigated the implications of the SCr(10d) concentration for graft prognosis. The SCr(10d) correlated weakly with graft survival (Cox, P=0.05). However, an elevated SCr(10d) correlated with other potential risk factors for graft survival including: Older donors (P<0.0001), male recipients (P<0.0001), and heavier recipients (P<0.0001, all by multivariate regression); and posttransplant factors such as, increasing numbers of AR (P<0.0001), higher posttransplant blood pressure (P<0.0001), and lower doses of cyclosporine (P<0.0001, all by multivariate regression). In conclusion, graft dysfunction predicts poor graft survival only when associated with AR. Similarly, AR predicts a poor renal allograft survival only when associated with graft dysfunction. The SCr(10d) is an indicator of risk factors from both the donor and recipient, and an elevated SCr(10d) predicts a higher risk of acquiring additional risk factors early after transplantation.

Authors+Show Affiliations

Division of Nephrology, The Ohio State University, Columbus 43210, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9197355

Citation

Cosio, F G., et al. "Impact of Acute Rejection and Early Allograft Function On Renal Allograft Survival." Transplantation, vol. 63, no. 11, 1997, pp. 1611-5.
Cosio FG, Pelletier RP, Falkenhain ME, et al. Impact of acute rejection and early allograft function on renal allograft survival. Transplantation. 1997;63(11):1611-5.
Cosio, F. G., Pelletier, R. P., Falkenhain, M. E., Henry, M. L., Elkhammas, E. A., Davies, E. A., Bumgardner, G. L., & Ferguson, R. M. (1997). Impact of acute rejection and early allograft function on renal allograft survival. Transplantation, 63(11), 1611-5.
Cosio FG, et al. Impact of Acute Rejection and Early Allograft Function On Renal Allograft Survival. Transplantation. 1997 Jun 15;63(11):1611-5. PubMed PMID: 9197355.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of acute rejection and early allograft function on renal allograft survival. AU - Cosio,F G, AU - Pelletier,R P, AU - Falkenhain,M E, AU - Henry,M L, AU - Elkhammas,E A, AU - Davies,E A, AU - Bumgardner,G L, AU - Ferguson,R M, PY - 1997/6/15/pubmed PY - 1997/6/15/medline PY - 1997/6/15/entrez SP - 1611 EP - 5 JF - Transplantation JO - Transplantation VL - 63 IS - 11 N2 - Both acute rejection and the function of a renal allograft early after transplantation correlate with long-term graft survival. In this study we assessed the relationship between these two factors in 843 adult recipients of first cadaveric renal grafts, transplanted at a single institution and followed for a minimum of 3.5 years. Patients were divided into four groups according to (1) history of acute rejection (AR) during the first 6 months after transplantation, and (2) concentration of serum creatinine at 6 months after transplantation (SCr(6mo) < or > or = 2 mg/dl). Death censored allograft survival was not significantly different among patients without AR and with low SCr(6mo) (group 1, n=376), patients without AR but with an elevated SCr(6mo) (group 2, n=117), and patients with AR but low SCr(6mo) (group 3, n=185). In contrast, graft survival was significantly worse in patients with AR and an elevated SCr(6mo) (group 4, n=165) compared with patients in the other three groups (Cox, P<0.0001). The elevated SCr(6mo) in group 4 patients was not necessarily the consequence of AR, as 32% of patients in group 4 had a SCr at 10 days after transplantation (SCr(10d)), before they had AR, that was equal to or higher than the SCr(6mo). Based on this observation we investigated the implications of the SCr(10d) concentration for graft prognosis. The SCr(10d) correlated weakly with graft survival (Cox, P=0.05). However, an elevated SCr(10d) correlated with other potential risk factors for graft survival including: Older donors (P<0.0001), male recipients (P<0.0001), and heavier recipients (P<0.0001, all by multivariate regression); and posttransplant factors such as, increasing numbers of AR (P<0.0001), higher posttransplant blood pressure (P<0.0001), and lower doses of cyclosporine (P<0.0001, all by multivariate regression). In conclusion, graft dysfunction predicts poor graft survival only when associated with AR. Similarly, AR predicts a poor renal allograft survival only when associated with graft dysfunction. The SCr(10d) is an indicator of risk factors from both the donor and recipient, and an elevated SCr(10d) predicts a higher risk of acquiring additional risk factors early after transplantation. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/9197355/Impact_of_acute_rejection_and_early_allograft_function_on_renal_allograft_survival_ L2 - http://dx.doi.org/10.1097/00007890-199706150-00013 DB - PRIME DP - Unbound Medicine ER -