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

被引:34
作者
Madden, RL [1 ]
Mulhern, JG [1 ]
Benedetto, BJ [1 ]
O'Shea, MH [1 ]
Germain, MJ [1 ]
Braden, GL [1 ]
O'Shaughnessy, J [1 ]
Lipkowitz, GS [1 ]
机构
[1] Tufts Univ, Sch Med, Baystate Med Ctr, Dept Surg,Div Transplantat, Springfield, MA 01199 USA
关键词
renal transplantation; acute rejection; chronic rejection;
D O I
10.1111/j.1432-2277.2000.tb01008.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
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 (IoCl) measured at 3 months and yearly thereafter were used to separate recipients into 2 groups. Ln 61 patients (stable group), there was no significant decrease ( > 20 % reduction in IoCl over 2 consecutive years) in IoCl. 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 % (42/42 episodes of AR in 29 patients) complete reversal whereas only 32 % (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 % (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 BR had stable long-term function as measured by IoCl. AR is not invariably deleterious to longterm renal graft function if each episode of AR can be completely reversed.
引用
收藏
页码:344 / 350
页数:7
相关论文
共 24 条
[1]   RISK-FACTORS FOR CHRONIC REJECTION IN RENAL-ALLOGRAFT RECIPIENTS [J].
ALMOND, PS ;
MATAS, A ;
GILLINGHAM, K ;
DUNN, DL ;
PAYNE, WD ;
GORES, P ;
GRUESSNER, R ;
NAJARIAN, JS ;
FERGUSON ;
PAUL ;
SCHAFFER .
TRANSPLANTATION, 1993, 55 (04) :752-757
[2]   EARLY VERSUS LATE ACUTE RENAL-ALLOGRAFT REJECTION - IMPACT ON CHRONIC REJECTION [J].
BASADONNA, GP ;
MATAS, AJ ;
GILLINGHAM, KJ ;
PAYNE, WD ;
DUNN, DL ;
SUTHERLAND, DER ;
GORES, PF ;
GRUESSNER, RWG ;
NAJARIAN, JS .
TRANSPLANTATION, 1993, 55 (05) :993-995
[3]   PREDICTION OF CREATININE CLEARANCE FROM SERUM CREATININE [J].
COCKCROFT, DW ;
GAULT, MH .
NEPHRON, 1976, 16 (01) :31-41
[4]   Impact of acute rejection and early allograft function on renal allograft survival [J].
Cosio, FG ;
Pelletier, RP ;
Falkenhain, ME ;
Henry, ML ;
Elkhammas, EA ;
Davies, EA ;
Bumgardner, GL ;
Ferguson, RM .
TRANSPLANTATION, 1997, 63 (11) :1611-1615
[5]  
DEGEEST S, 1995, TRANSPLANTATION, V59, P340
[6]   CAUSES OF GRAFT LOSS BEYOND 2 YEARS IN THE CYCLOSPORINE ERA [J].
DUNN, J ;
GOLDEN, D ;
VANBUREN, CT ;
LEWIS, RM ;
LAWEN, J ;
KAHAN, BD .
TRANSPLANTATION, 1990, 49 (02) :349-353
[7]  
FERGUSON R, 1994, CLIN TRANSPLANT, V8, P328
[8]  
GERMAIN MJ, 1992, CLIN TRANSPLANT, V6, P62
[9]   THE INCIDENCE AND IMPACT OF EARLY REJECTION EPISODES ON GRAFT OUTCOME IN RECIPIENTS OF 1ST CADAVER KIDNEY-TRANSPLANTS [J].
GULANIKAR, AC ;
MACDONALD, AS ;
SUNGURTEKIN, U ;
BELITSKY, P .
TRANSPLANTATION, 1992, 53 (02) :323-328
[10]  
ISONIEMI H, 1995, TRANSPLANT P, V27, P875