THE IMPACT OF AN ACUTE REJECTION EPISODE ON LONG-TERM RENAL ALLOGRAFT SURVIVAL (t1/2)1,2

Matas, A. J.; Gillingham, Kristen J.; Payne, William D.; Najarían, John S.

doi:10.1097/00007890-199403270-00015

Cited by 421 publications

(187 citation statements)

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“…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%

“…Recent, large retrospective studies have shown that the occurrence of even one episode of AR significantly reduced long-term renal graft survival [7,17,19,23]. Episodes of AR have also been shown to correlate with the development of chronic rejection (CR) [l, 2, 7, 12, 16, 171.…”

Section: Introductionmentioning

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: 87%

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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“…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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“…Such rejection episodes naturally eliminate the grafts from long-term survival analyses, such as the determination of transplant half-life, which only include grafts surviving the first post-transplant year. Matas et al [13] demonstrated how even a single episode of acute rejection influences the half-life of primary renal grafts.…”

Section: Nt Rod Udionmentioning

confidence: 99%

The clinical significance of conversion of complement-dependent cytotoxic T cell crossmatch test after renal transplantation

Kyllönen¹,

Salmela²,

Koskimies

1999

Transplant Int

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The purpose of this study was to investigate the clinical relevance of conversion of post-transplant T cell crossmatch between kidney donor and recipient. This study comprises 892 cadaveric renal transplantations performed on 874 adult patients between August 1991 and December 1997. Recipient selection was based on a negative complement-dependent cytotoxic T cell crossmatch test with current ( 5 2 months old) serum. For this study, on day 0 and day 14 after transplantation, serum samples were collected for later crossmatching. On day 14 after transplantation, the crossmatch had converted to positive in 76 transplantations (8.5 Yo).Acute rejection occurred in 50 YO of the converters and 22 % of the nonconverters ( P < 0.005), and graft survival was significantly poorer ( P < 0.025), being 85 vs 94 YO at 1 and 68 vs 83 YO at 5 years, respectively. In patients with delayed graft function, l-year graft survival was 77 Yo in the converters and 91 YO in the non-converters ( P < 0.05). Conversion of T cell crossmatch, especially in connection with delayed graft function, identifies a subgroup of patients at high risk of severe rejection and poor graft survival.

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THE IMPACT OF AN ACUTE REJECTION EPISODE ON LONG-TERM RENAL ALLOGRAFT SURVIVAL (t1/2)1,2

Cited by 421 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

The clinical significance of conversion of complement-dependent cytotoxic T cell crossmatch test after renal transplantation

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