Risk factors for chronic rejection in renal allograft recipients

P. S. Almond, A. Matas, K. Gillingham, D. L. Dunn, W. D. Payne, P. Gores, Rainer W G Gruessner, J. S. Najarian

Research output: Contribution to journalArticle

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Abstract

Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD, 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P = .08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P<.0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (<18 years, 18 to 50 years, >50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (<5 mg/kg vs. ≥5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P<.001), CsA dosage <5 mg/kg/day at 1 year (P=.007), infection (P=.023), female gender (P=.042), and retransplant (P=.103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage <5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections).

Original languageEnglish (US)
Pages (from-to)752-757
Number of pages6
JournalTransplantation
Volume55
Issue number4
StatePublished - 1993
Externally publishedYes

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Allografts
Transplants
Kidney
Infection
Biopsy
Logistic Models
Living Donors
Cytomegalovirus Infections
Graft Survival
HLA Antigens
Cadaver
Immunosuppression
Cyclosporine
Tissue Donors
Databases
Cytokines
Survival
Antibodies
Incidence

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Almond, P. S., Matas, A., Gillingham, K., Dunn, D. L., Payne, W. D., Gores, P., ... Najarian, J. S. (1993). Risk factors for chronic rejection in renal allograft recipients. Transplantation, 55(4), 752-757.

Risk factors for chronic rejection in renal allograft recipients. / Almond, P. S.; Matas, A.; Gillingham, K.; Dunn, D. L.; Payne, W. D.; Gores, P.; Gruessner, Rainer W G; Najarian, J. S.

In: Transplantation, Vol. 55, No. 4, 1993, p. 752-757.

Research output: Contribution to journalArticle

Almond, PS, Matas, A, Gillingham, K, Dunn, DL, Payne, WD, Gores, P, Gruessner, RWG & Najarian, JS 1993, 'Risk factors for chronic rejection in renal allograft recipients', Transplantation, vol. 55, no. 4, pp. 752-757.
Almond PS, Matas A, Gillingham K, Dunn DL, Payne WD, Gores P et al. Risk factors for chronic rejection in renal allograft recipients. Transplantation. 1993;55(4):752-757.
Almond, P. S. ; Matas, A. ; Gillingham, K. ; Dunn, D. L. ; Payne, W. D. ; Gores, P. ; Gruessner, Rainer W G ; Najarian, J. S. / Risk factors for chronic rejection in renal allograft recipients. In: Transplantation. 1993 ; Vol. 55, No. 4. pp. 752-757.
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abstract = "Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD, 248 CAD). The 5-year patient survival was 84{\%} for recipients with biopsy-proven chronic rejection vs. 89{\%} without (P = .08). The 5-year graft survival was 31{\%} for recipients with biopsy-proven chronic rejection vs. 81{\%} without (P<.0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (<18 years, 18 to 50 years, >50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (<5 mg/kg vs. ≥5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P<.001), CsA dosage <5 mg/kg/day at 1 year (P=.007), infection (P=.023), female gender (P=.042), and retransplant (P=.103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage <5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections).",
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T1 - Risk factors for chronic rejection in renal allograft recipients

AU - Almond, P. S.

AU - Matas, A.

AU - Gillingham, K.

AU - Dunn, D. L.

AU - Payne, W. D.

AU - Gores, P.

AU - Gruessner, Rainer W G

AU - Najarian, J. S.

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N2 - Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD, 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P = .08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P<.0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (<18 years, 18 to 50 years, >50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (<5 mg/kg vs. ≥5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P<.001), CsA dosage <5 mg/kg/day at 1 year (P=.007), infection (P=.023), female gender (P=.042), and retransplant (P=.103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage <5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections).

AB - Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD, 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P = .08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P<.0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (<18 years, 18 to 50 years, >50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (<5 mg/kg vs. ≥5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P<.001), CsA dosage <5 mg/kg/day at 1 year (P=.007), infection (P=.023), female gender (P=.042), and retransplant (P=.103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage <5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections).

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