Decreased acute rejection in kidney transplant recipients is associated with decreased chronic rejection

Arthur J. Matas, Abhinav Humar, William D. Payne, Kristen J. Gillingham, David L. Dunn, David E R Sutherland, John S. Najarian

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

Objective: To determine whether a recent decrease in the rate of acute rejection after kidney transplantation was associated with a decrease in the rate of chronic rejection. Summary Background Data: Single-institution and multicenter retrospective analyses have identified acute rejection episodes as the major risk factor for chronic rejection after kidney transplantation. However, to date, no study has shown that a decrease in the rate of acute rejection leads to a decrease in the rate of chronic rejection. Methods: The authors studied patient populations who underwent transplants at a single center during two eras (1984-1987 and 1991-1994) to determine the rate of biopsy-proven acute rejection, the rate of biopsy-proven chronic rejection, and the graft half-life. Results: Recipients who underwent transplantation in era 2 had a decreased rate of biopsy-proven acute rejection compared with era 1 (p < 0.05). This decrease was associated with a decreased rate of biopsy- proven chronic rejection for both cadaver (p = 0.0001) and living donor (p = 0.08) recipients. A trend was observed toward increased graft half-life in era 2 (p = NS). Conclusions: Development of immunosuppressive protocols that decrease the rate of acute rejection should lower the rate of chronic rejection and improve long-term graft survival.

Original languageEnglish (US)
Pages (from-to)493-500
Number of pages8
JournalAnnals of surgery
Volume230
Issue number4
DOIs
StatePublished - Oct 1999

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