Early Versus Late Acute Renal Allograft Rejection

Basadonna, Giacomo; Matas, Arthur J.; Gillingham, Kristen J.; Payne, William D.; Dünn, David L.; Sutherland, David E.R.; Gores, P. F.; Gruessner, Rainer W.G.; Najarían, John S.

doi:10.1097/00007890-199305000-00007

Cited by 340 publications

(128 citation statements)

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“…This rate of AR is consistent with the results of other transplant centers in the United States [2,19,231. Although the differences in number and timing of AR episodes did not reach significance, the one clearly striking difference between the groups was the completeness of reversal of rejection.…”

Section: Discussionsupporting

confidence: 90%

“…Although not reaching statistical significance, our results are consistent with previous studies that have shown an increasing number of AR episodes and later episodes of AR to be risk factors for graft loss [2,7,9,13,17,19,23]. We found a trend ( P = 0.096) toward an increased number of AR episodes per patient in those that developed deteriorating function.…”

Section: Discussionsupporting

confidence: 87%

“…In other recipients, however, episodes of AR did seem to lead to CR and graft loss. Review of the literature pointed to differences in AR in terms of number, timing, and/or severity as etiologies of the different long-term results of AR [l, 2,7,9,12,13,16,[17][18][19]23,24]. Utilizing an accurate assay (IoC1) for the assessment of renal function, the goal of our study was to identify what differences, if any, existed in episodes of AR that led to CR versus those in which AR did not seem to affect long-term function.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to diminished long-term function and reduced graft survival, AR has also been found to correlate with an increased rate of CR [1,2,7,12,16,171. Our study showed that the risk of CR is much greater in recipients with incompletely reversed AR compared to those with complete reversal.…”

Section: Discussionmentioning

confidence: 99%

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Completely reversed acute rejection is not a significant risk factor for the development of chronic rejection in renal allograft recipients

Madden¹,

Mulhern²,

Benedetto³

et al. 2000

Transplant Int

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Although acute rejection (AR) has been shown to correlate with decreased long-term renal allograft survival, we have noted AR in recipients who subsequently had stable function for more than 5 years. We reviewed 109 renal graft recipients with a minimum of 1 year graft survival and follow-up of 5-8 years. Post-transplant sodium iothalamate clearances (IoC1) measured at 3 months and yearly thereafter were used to separate recipients into 2 groups. In 61 patients (stable group), there was no significant decrease ( > 20% reduction in IoCl over 2 consecutive years) in IoC1. Forty-eight patients had significant declines in IoCl (decline group). Groups were compared for incidence, severity, timing, and completeness of reversal of AR. Rejection was considered completely reversed if the post-AR serum creatinine (Scr) returned to or below the pre-AR nadir Scr after antirejection therapy. The incidence of AR was not significantly different between groups (47 % vs 52 %). A trend toward a lower mean number of AR episodes per patient was noted in the stable group (0.69 vs 1.04, P = 0.096), but the timing of AR was not different. Steroid-resistant AR occurred in approximately 25 % of both groups. A striking difference was seen in complete reversal of AR, with the stable group having 100 YO (42/42 episodes of AR in 29 patients) complete reversal whereas only 32 YO (8/25) of the patients in the decline group had complete reversal ( P < < 0.001). Of 8 declining patients with complete reversal, graft loss was due to chronic rejection (CR) in only 3. Seventeen declining patients had incomplete reversal of AR, and 82 '30 (14/17) lost their grafts to CR. Overall, only 8 % (3/37) of the recipients with complete reversal of AR developed CR. No patients with incompletely reversed AR had stable long-term function as measured by IoCI. AR is not invariably deleterious to longterm renal graft function if each episode of AR can be completely reversed.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Completely reversed acute rejection is not a significant risk factor for the development of chronic rejection in renal allograft recipients

Madden¹,

Mulhern²,

Benedetto³

et al. 2000

Transplant Int

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“…However, despite recent advances in immunosuppression, acute rejection of the transplanted organ remains a major postoperative problem and is associated with a significantly increased risk for chronic graft rejection and graft loss. [1][2][3][4][5][6] In liver transplant recipients, current immunosuppressive regimens based on cyclosporine (CsA) or tacrolimus are still associated with acute rejection rates of 35% to 55% and 12-month graft and patient survival rates of only 70% to 80% and 80% to 85%, respectively. 7,8 In contrast to renal transplantation, no direct correlation between the occurrence of acute rejection and long-term graft function can be established.…”

mentioning

confidence: 99%

Immunoprophylaxis with basiliximab, a chimeric anti[ndash ]interleukin-2 receptor monoclonal antibody, in combination with azathioprine-containing triple therapy in liver transplant recipients

Calmus

2002

Liver Transplantation

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Acute graft rejection remains a major problem among additional sequelae in liver transplant recipients. Basiliximab, a chimeric monoclonal antibody with high affinity for the CD25 chain of the interleukin-2 receptor, has significantly reduced the incidence of acute rejection episodes in renal transplant recipients. This single-arm, open-label, multicenter study investigated the efficacy and tolerability of basiliximab immunoprophylaxis in adult patients undergoing first elective liver transplantation. One hundred one patients (70 hepatitis C virus [HCV]-negative patients, 31 HCV-positive patients) were administered basiliximab, 20 mg, by intravenous bolus injection the day of transplantation (day 0) and day 4. In addition, all patients were administered triple immunosuppressive therapy with cyclosporine, steroids, and azathioprine. The efficacy of basiliximab was assessed by conventional parameters, and tolerability was assessed by the incidence of adverse events, infections, and laboratory test result abnormalities. At 6 months, the incidence of first acute biopsy-confirmed rejection episodes was 22.8%. Rejections were more frequent in the HCV-positive (29.0%) than HCV-negative subgroup (20.0%; P ‫؍‬ .441). No rejection episode was graded histologically as severe, and no patient required antibody therapy for the management of acute rejection. Ten patients (9.9%) required treatment with tacrolimus for acute rejection episodes. Patient and graft survival rates at 12 months were 90.1% and 88.1%, respectively. Basiliximab caused no injection-site reactions, anaphylaxis, or cytokine release syndrome. Five malignancies were reported at 12 months: of these, three malignancies predated transplantation surgery. Compared with earlier studies, the addition of basiliximab immunoprophylaxis to triple immunosuppressive therapy provides increased efficacy in reducing the incidence of acute rejection episodes, with no clinically significant increase in adverse events. (Liver Transpl 2002;8: 123-131.)

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Association of Ambient Fine Particulate Matter Air Pollution With Kidney Transplant Outcomes

et al. 2021

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IMPORTANCE Increased levels of ambient fine particulate matter (PM 2.5 ) air pollution are associated with increased risks for detrimental health outcomes, but risks for patients with kidney transplants (KTs) remain unknown. OBJECTIVE To investigate the association of PM 2.5 exposure with KT outcomes. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted using data on patients who received KTs from 2004 to 2016 who were identified in the national US transplant registry and followed up through March 2021. Multiple databases were linked to obtain data on PM 2.5 concentration, KT outcomes, and patient clinical, transplant, and contextual factors. Data were analyzed from April 2020 through July 2021.EXPOSURES Exposures included post-KT time-dependent annual mean PM 2.5 level (in 10 μg/m 3 ) and mean PM 2.5 level in the year before KT (ie, baseline levels) in quartiles, as well as baseline annual mean PM 2.5 level (in 10 μg/m 3 ). MAIN OUTCOMES AND MEASURESAcute kidney rejection (ie, rejection within 1 year after KT), time to death-censored graft failure, and time to all-cause death. Multivariable logistic regression for kidney rejection and Cox analyses with nonlinear assessment of exposure-response for deathcensored graft failure and all-cause death were performed. The national burden of graft failure associated with PM 2.5 levels greater than the Environmental Protection Agency recommended level of 12 μg/m 3 was estimated. RESULTS Among 112 098 patients with KTs, 70 522 individuals (62.9%) were older than age 50 years at the time of KT, 68 117 (60.8%) were men, and the median (IQR) follow-up was 6.0 (3.9-8.9) years. There were 37 265 Black patients (33.2%), 17 047 Hispanic patients (15.2%), 48 581 White patients [43.3%]), and 9205 patients (8.2%) of other race or ethnicity. The median (IQR) baseline PM 2.5 level was 9.8 (8.3-11.9) μg/m 3 . Increased baseline PM 2.5 level, compared with quartile 1 baseline PM 2.5 level, was not associated with higher odds of acute kidney rejection for quartile 2 (adjusted odds ratio [aOR], 0.99; 95% CI, 0.92-1.06) but was associated with increased odds for quartile 3 (aOR, 1.11; 95% CI, 1.04-1.20) and quartile 4 (aOR, 1.13; 95% CI, 1.05-1.23). Nonlinear assessment of exposure-response for graft failure and death showed no evidence for nonlinearity. Increased PM 2.5 levels were associated with increased risk of death-censored graft failure (adjusted hazard ratio[aHR] per 10 μg/m 3 increase, 1.17; 95% CI, 1.09-1.25) and all-cause death (aHR per 10 μg/m 3 increase, 1.21; 95% CI, 1.14-1.28). The national burden of death-censored graft failure associated with PM 2.5 above 12 μg/m 3 was 57 failures (95% uncertainty interval, 48-67 failures) per year among patients with KTs.

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Early Versus Late Acute Renal Allograft Rejection

Cited by 340 publications

References 0 publications

Completely reversed acute rejection is not a significant risk factor for the development of chronic rejection in renal allograft recipients

Completely reversed acute rejection is not a significant risk factor for the development of chronic rejection in renal allograft recipients

Immunoprophylaxis with basiliximab, a chimeric anti[ndash ]interleukin-2 receptor monoclonal antibody, in combination with azathioprine-containing triple therapy in liver transplant recipients

Association of Ambient Fine Particulate Matter Air Pollution With Kidney Transplant Outcomes

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