Factors Predicting Long‐term Graft Survival after Kidney Transplantation: Multicenter Study in Japan

Abstract

A multicenter retrospective study was conducted in 936 living donor kidney transplant recipients treated with cyclosporine (CsA) or tacrolimus (FK) from April 1982. The influences of acute rejection, hyperlipidemia, and hypertension were estimated by Kaplan-Meier's analysis and Wilcoxon's analysis. Of 916 recipients, 532 (58.1%) had acute rejections. The 5- and 10-year graft survival rates in the recipients with acute rejection were 75.2% and 55.2%, respectively. The corresponding rates of the recipients without acute rejection were 80.2% and 70.6%, respectively. The graft survival rate was worse in recipients with late-phase rejection and multiple rejection episodes (p < 0.00006). Of 451 recipients, 176 (39.0%) had hypercholesterolemia 3 years after kidney transplantation. The 5- and 10-year graft survival rates in the recipients with hypercholesterolemia were 88.7% and 68.7%, respectively. Those of the recipients without hypercholesterolemia were 95.2% and 83.9%, respectively. The graft survival rate in the recipients with hypercholesterolemia was lower than that in the recipients without hypercholesterolemia (p = 0.003). Of 323 recipients, 123 (38.1%) had hypertriglyceridemia 3 years after kidney transplantation. The 5- and 10-year graft survival rates in the recipients with hypertriglyceridemia were 93.7% and 80.5%, respectively. Those in the recipients without hypertriglyceridemia were 95.1% and 86.5%, respectively. The graft survival rate in the recipients with hypertriglyceridemia was lower than that in the recipients without hypertriglyceridemia (p = 0.371). Of 367 recipients, 151 (41.1%) had systolic hypertension 3 years after kidney transplantation. The 5- and 10-year graft survival rates in the recipients with hypertension were 85.6% and 64.7%, respectively. Those of the recipients without hypertension were 95.6% and 83.8%, respectively. The graft survival rate in the recipients with hypertension was lower than that in the recipients without hypertension (p < 0.001). Acute rejection, hyperlipidemia (hypercholesterolemia and hypertriglyceridemia), and hypertension are predictive factors for long-term graft survival. Especially the onset time, number of rejections, and efficacy of treatment for acute rejection would have a significant influence on long-term graft survival.

Belatacept-Based Regimens Are Associated With Improved Cardiovascular and Metabolic Risk Factors Compared With Cyclosporine in Kidney Transplant Recipients (BENEFIT and BENEFIT-EXT Studies)

“…The consequences of hypertension are serious and include poorer renal function (39) and diminished patient/graft survival (40,41). For example, a retrospective analysis of kidney transplant patients found that each 10 mm Hg increase in posttransplant systolic blood pressure was associated with a 10% to 20% increased risk for graft failure and death (12).…”

Eficácia, tolerabilidade e segurança do uso do sirolimo após o transplante renal

“…36 Entretanto, a magnitude do aumento nas concentrações médias de colesterol e triglicérides foi pequena, apesar de maior entre os pacientes recebendo CSA, com tendência à redução após o primeiro ano do transplante. 7,16 Finalmente, apesar da possibilidade de interferência do SRL sobre o metabolismo de carboidratos, a concentração média de glicose ficou dentro dos limites de normalidade, não se observando diferença entre os pacientes que receberam CSA ou TAC.…”

Steroid Avoidance Regimens: A Comparison of Outcomes with Maintenance Steroids versus Continued Steroid Avoidance in Recipients Having an Acute Rejection Episode

“…The benefit of maintenance steroids did not seem to be as pronounced when the 1st AR episode was moderate/severe or had a humoral component-but even in these groups there seemed to be some advantage to maintenance steroids. This potential for increased risk of a 2nd AR episode in those recipients that remained steroid free is of obvious concern because of the negative impact of multiple rejection episodes on longterm graft survival (15)(16)(17). Also of concern is the fact that 5 of the 81 recipients that remained steroid free eventually went on to graft loss because of a repeat AR episode.…”