Clinical Profile and Course and Outcome of Late Acute Rejection Episodes in Living-Related-Donor Renal Allograft Recipients

Abstract

We prospectively monitored clinical data and renal function at monthly intervals in 165 patients who had received living-related-donor renal allografts in our institution between January 1981 and December 1991 and had a functioning allograft for 1 year or longer. During a mean follow-up period of 47.2 (range 13-155) months, 32 patients (17.2%) developed late acute rejections, of which 14 (43.7%) were asymptomatic. Amongst the symptomatic late acute rejections, worsening of hypertension was the commonest finding, being present in 11 (61.1%) patients, followed by oliguria in 8 (44.4%) and weight gain in 7 (38.8%) patients. Of these 32 late acute rejections, as many as 28 (87.5%) showed a response to antirejection therapy with high-dose steroids: 5 (15.6%) a complete response and 23 (71.9%) a partial response. The response rate was 100% if it was the first acute rejection (20% complete and 80% partial), 78.6% if it was the second (14.3% complete and 64.3% partial), and no or only a partial response to treatment if it was the third acute rejection episode. On long-term follow-up, patients who had responded to antirejection treatment had a significantly better graft survival as compared with nonresponding patients: 76 and 27%, respectively. Our observations suggest that routine monitoring of the renal function at frequent intervals is essential for early diagnosis and treatment of acute rejections, even during the late posttransplant period. The chances of a response to antirejection therapy are higher during the first episode of late acute transplant rejection as compared with a second or a third late rejection event.

Factors Predicting Long‐term Graft Survival after Kidney Transplantation: Multicenter Study in Japan

“…It has been reported that the relative risk for graft loss with one AR episode versus no AR episode was 2.7, and multiple AR episodes increased the relative risk to 7.8 [4, 5]. With an increase in the number of AR episodes, the response to antirejection therapy became worse and the rate of complete response decreased [6].…”

The impact of late acute rejection after cadaveric kidney transplantation

“…The reported incidence of LAR has varied between studies from 2.5 to 38% [17–22]. Wrenshall et al [20] report an incidence of 2.5 to 6.5% of AR episodes after 1 yr. Rao and Rose [17] observed that 15% of patients developed AR between 1 and 2 yr post‐transplant; the rate falling to 2% between 5 and 6 yr. Also, a very high incidence (38%) has been quoted where protocol biopsies have been employed [22].…”

Follow‐up biopsies identify high rates of persistent rejection in pediatric kidney transplant recipients after treatment of T cell‐mediated rejection

“…Importantly, no studies supporting corticosteroid regimens in TCMR have including histological confirmation of resolution. [22][23][24][26][27][28] In our study, although patients with borderline TCMR were more likely to demonstrate complete resolution of rejection on FUB compared to grade ≥1A TCMR, 32% had no improvement and a further 15% had worse rejection despite treatment. A similar proportion with grade ≥1A TCMR (46%) had no treatment response to the initial standard treatment whatsoever.…”

“…There are also reports exploring longer duration of IV corticosteroid treatment for 5 or 6 days, 25 but these have not been subjected to comparative trials to evaluate their efficacy relatively to 3‐day regimens. Importantly, no studies supporting corticosteroid regimens in TCMR have including histological confirmation of resolution 22–24,26–28 . In our study, although patients with borderline TCMR were more likely to demonstrate complete resolution of rejection on FUB compared to grade ≥1A TCMR, 32% had no improvement and a further 15% had worse rejection despite treatment.…”