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The impact of early and late acute rejection on graft survival in renal transplantation.

Koo EH, Jang HR, Lee JE, Park JB, Kim SJ, Kim DJ, Kim YG, Oh HY, Huh W - Kidney Res Clin Pract (2015)

Bottom Line: When we set LAR as standard and compared it with EAR, there was no statistical difference between EAR and LAR (P=0.21).AR, regardless of its timing, significantly worsened graft survival.Treatments to reduce the incidence of AR and improve prognosis are needed.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background: Advances in immunosuppression after kidney transplantation have decreased the influence of early acute rejection (EAR) on graft survival. Several studies have suggested that late acute rejection (LAR) has a poorer effect on long-term graft survival than EAR. We investigated whether the timing of acute rejection (AR) influences graft survival, and analyzed the risk factors for EAR and LAR.

Methods: We performed a retrospective cohort study involving 709 patients who underwent kidney transplantation between 2000 and 2009 at the Samsung Medical Center, Seoul, Korea. Patients were divided into three groups: no AR, EAR, and LAR. EAR and LAR were defined as rejection before 1 year and after 1 year, respectively. Differences in graft survival between the three groups and risk factors of graft failure were analyzed.

Results: Of the 709 patients, 198 (30%) had biopsy-proven AR [EAR=152 patients (77%); LAR=46 patients (23%)]. A total of 65 transplants were lost. The 5-year graft survival rates were 97%, 89%, and 85% for patients with no AR, EAR, and LAR, respectively. These differences were significant (P<0.001 for both by log-rank test). In time-dependent Cox regression analysis, EAR (hazards ratio, 3.37; 95% confidence interval, 1.90-5.99) and LAR (hazards ratio, 5.32; 95% confidence interval, 2.65-10.69) were significantly related to graft failure. When we set LAR as standard and compared it with EAR, there was no statistical difference between EAR and LAR (P=0.21).

Conclusion: AR, regardless of its timing, significantly worsened graft survival. Treatments to reduce the incidence of AR and improve prognosis are needed.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier graft survival for transplants without AR, with EAR, and with LAR. AR, acute rejection; EAR, early acute rejection; LAR, late acute rejection.
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f0005: Kaplan–Meier graft survival for transplants without AR, with EAR, and with LAR. AR, acute rejection; EAR, early acute rejection; LAR, late acute rejection.

Mentions: Allograft failure occurred in 65 patients. The 5-year graft survival rates were 97%, 89%, and 85% for patients with no AR, EAR, and LAR, respectively (Fig. 1). The patients with EAR or LAR showed lower graft survival rates than those with no AR (P<0.001 for both by log-rank test). The graft survival rates were not different between the EAR group and LAR group (P=0.22 by log-rank test).


The impact of early and late acute rejection on graft survival in renal transplantation.

Koo EH, Jang HR, Lee JE, Park JB, Kim SJ, Kim DJ, Kim YG, Oh HY, Huh W - Kidney Res Clin Pract (2015)

Kaplan–Meier graft survival for transplants without AR, with EAR, and with LAR. AR, acute rejection; EAR, early acute rejection; LAR, late acute rejection.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608868&req=5

f0005: Kaplan–Meier graft survival for transplants without AR, with EAR, and with LAR. AR, acute rejection; EAR, early acute rejection; LAR, late acute rejection.
Mentions: Allograft failure occurred in 65 patients. The 5-year graft survival rates were 97%, 89%, and 85% for patients with no AR, EAR, and LAR, respectively (Fig. 1). The patients with EAR or LAR showed lower graft survival rates than those with no AR (P<0.001 for both by log-rank test). The graft survival rates were not different between the EAR group and LAR group (P=0.22 by log-rank test).

Bottom Line: When we set LAR as standard and compared it with EAR, there was no statistical difference between EAR and LAR (P=0.21).AR, regardless of its timing, significantly worsened graft survival.Treatments to reduce the incidence of AR and improve prognosis are needed.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background: Advances in immunosuppression after kidney transplantation have decreased the influence of early acute rejection (EAR) on graft survival. Several studies have suggested that late acute rejection (LAR) has a poorer effect on long-term graft survival than EAR. We investigated whether the timing of acute rejection (AR) influences graft survival, and analyzed the risk factors for EAR and LAR.

Methods: We performed a retrospective cohort study involving 709 patients who underwent kidney transplantation between 2000 and 2009 at the Samsung Medical Center, Seoul, Korea. Patients were divided into three groups: no AR, EAR, and LAR. EAR and LAR were defined as rejection before 1 year and after 1 year, respectively. Differences in graft survival between the three groups and risk factors of graft failure were analyzed.

Results: Of the 709 patients, 198 (30%) had biopsy-proven AR [EAR=152 patients (77%); LAR=46 patients (23%)]. A total of 65 transplants were lost. The 5-year graft survival rates were 97%, 89%, and 85% for patients with no AR, EAR, and LAR, respectively. These differences were significant (P<0.001 for both by log-rank test). In time-dependent Cox regression analysis, EAR (hazards ratio, 3.37; 95% confidence interval, 1.90-5.99) and LAR (hazards ratio, 5.32; 95% confidence interval, 2.65-10.69) were significantly related to graft failure. When we set LAR as standard and compared it with EAR, there was no statistical difference between EAR and LAR (P=0.21).

Conclusion: AR, regardless of its timing, significantly worsened graft survival. Treatments to reduce the incidence of AR and improve prognosis are needed.

No MeSH data available.


Related in: MedlinePlus