The impact of late acute rejection after cadaveric kidney transplantation

Joseph, John; Kingsmore, David; Junor, B. J. R.; Briggs, J. D.; Woo, Y. Mun; Jaques, BC; Hamilton, David; Jardine, Alan G.; Jindal, Rahul M.

doi:10.1034/j.1399-0012.2001.150401.x

Cited by 76 publications

(56 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding could be related to the fact that AR occurred relatively late after transplantation (167 Ϯ 42 d). Indeed, previous reports have shown that late AR have a deleterious impact, especially when they occur after days 60 to 90 posttransplantation (15,16).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Acute Rejection after Early Cyclosporine Withdrawal in Renal Transplant Recipients Who Receive Mycophenolate Mofetil

Hazzan¹,

Labalette²,

Copin³

et al. 2005

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

The aim of this randomized, open-labeled trial was to compare the incidence of acute rejection after an early (3 mo posttransplantation) withdrawal of cyclosporine (CsA) or mycophenolate mofetil (MMF) in renal transplantation. Among 218 eligible recipients, 108 nonsensitized, rejection-free patients who were under a triple drug regimen (CsA-MMF-prednisone) and had received a first kidney from a deceased donor were enrolled. At 3 mo after graft, they were gradually withdrawn from CsA (MMF group, n ‫؍‬ 54) or MMF (CsA group, n ‫؍‬ 54). A graft biopsy and a pharmacokinetic study of CsA and mycophenolic acid were systematically performed before the randomization. At 1 yr, graft and patient survival rates were 100% in each group. Renal function was improved in the MMF group compared with the CsA group (Cockcroft calculated clearance 64.7 ؎ 18.7 versus 56.5 ؎ 18.0 ml/min; P ‫؍‬ 0.023). However, the probability of acute rejection was higher in the MMF group (18.5 versus 5.6%; P ‫؍‬ 0.045). The 10 patients who developed acute rejection after CsA withdrawal had a significantly higher incidence of borderline changes on the randomization biopsy than the 44 rejection-free patients (five of 10 versus eight of 44; P ‫؍‬ 0.034), and they displayed a lower area under the curve of mycophenolic acid (43 ؎ 9 versus 58 ؎ 22 mg/h per L; P ‫؍‬ 0.045). Multivariate analysis confirmed that borderline changes and area under the curve of mycophenolic acid were significant risk factors of acute rejection after CsA discontinuation. It is concluded that a systematic graft biopsy and a pharmacokinetic study of mycophenolic acid are needed to reduce the risk for acute rejection after CsA withdrawal.

show abstract

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Acute Rejection after Early Cyclosporine Withdrawal in Renal Transplant Recipients Who Receive Mycophenolate Mofetil

Hazzan¹,

Labalette²,

Copin³

et al. 2005

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…The etiology of chronic allograft nephropathy is not fully understood; however, acute rejection is an important risk factor. Especially late acute rejection episodes have been identified to have a strong correlation with late graft loss (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Prospective Study on Late Consequences of Subclinical Non-Compliance with Immunosuppressive Therapy in Renal Transplant Patients

Vlaminck¹,

Maes²,

Evers

et al. 2004

American Journal of Transplantation

206

164

View full text Add to dashboard Cite

In this prospective study we compared the incidence of late acute rejections (LAR) and changes in serumcreatinine over time between compliers and noncompliers with immunosuppressive therapy more than 1 year post transplantation and explored the relative contribution of non-compliance and other risk factors in the occurrence of LAR.One hundred and forty-six adult renal transplant recipients were followed during a 5-year period. Patients were interviewed at the beginning of the study and categorized as non-compliers if they admitted to have skipped immunosuppressive medication on a regular basis during the previous 12 months. The occurrence of LAR during the follow-up period was recorded.We identified 22.6% non-compliers of which 21.2% experienced a late acute rejection compared with 8% in the group of compliers at 5 years postinclusion (p < 0.05). Kaplan-Meier survival analysis showed a decreased rejection free time in non-compliers compared with compliers (p = 0.03). Non-compliant patients had a 3.2 higher risk of LAR (Cox regression analysis, p = 0.005). Non-compliers experienced a higher increase in serum-creatinine over time (Linear Mixed Models, p < 0.001).Non-compliance in renal transplant patients more than 1-year post transplantation is associated with an increased risk for LAR and a higher increase in serumcreatinine during the following 5 years.

show abstract

“…The 10-year graft SR for patients who have a previous episode of AR is 45%, reduced significantly compared to the patients with no AR (19). AR has a significant adverse impact on deceased donor allograft survival (18)(19)(20)(21), especially occurring after 3 months (20). Our patients have experienced less acute rejection episodes (21.8%), most likely because of their low immunologic risk.…”

Section: Discussionmentioning

confidence: 80%

“…Acute rejection is seen in 43.3-50.8% of DDKTx patients (18)(19)(20)(21). The 10-year graft SR for patients who have a previous episode of AR is 45%, reduced significantly compared to the patients with no AR (19).…”

Section: Discussionmentioning

confidence: 95%

“…The overall incidence of arterial thrombosis ranges between 0.4-3.0% and venous thrombosis between 0.4-3.4% in DDKTx patients (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Deceased donor is a significant risk factor for developing renal allograft thrombosis along with donor age <6 or >60 years, recipient age <5-6 or >50 years, hemodynamic instability, peritoneal dialysis, recipient vessel atherosclerosis, diabetic nephropathy, a history of thrombosis, and DGF (24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

Kumru¹,

Çelebi²,

Aktürk³

et al. 2016

Turk Neph Dial Transpl

View full text Add to dashboard Cite

OBJECTIVE:Renal transplantation is the treatment of choice in end-stage renal diseases. Long-term allograft function has remained steady in deceased donor kidney transplantation (DDKTx) during recent decades. In this study, we evaluated DDKTx outcomes at our hospital. MATERIAL and METHODS:72 cadaveric transplant patients who were grafted between January 2002 and October 2013 at our center were analysed retrospectively. Recipients and donors' demographic properties, immunologic and nonimmunologic characteristics, allograft function and emerging complications were examined. Factors associated with graft and patient loss were investigated. RESULTS:Mean follow-up period was 60±38 months. Mean recipient age was 42±11 years, of which 51.4% was male. Dialysis vintage was 83±59 months, while mean cold ischemia time was 12±3 hours. One and five year graft and patient survival rates were 94.4%, 92.3% and 97.2%, 89.9% respectively. High serum creatinine value at discharge (p=0.003) and early surgical complications (p=0.041) were independent risk factors associated with poor graft survival. Having a recipient age ≥46 years (p=0.037) and cardiovascular disease (p=0.017) caused patient loss. Cardiovascular disease was independently associated with patient loss (HR=6.45[1.08-38.70], p=0.041). CONCLUSION:In this study, it was demonstrated that creatinine value at discharge and early surgical complications were associated with allograft loss, while cardiovascular disease was associated with patient loss in DDKTx. BULGULAR: Ortalama takip süresi 60±38 aydır. Alıcıların ortalama yaşı 42±11 yıl, %51.4'ü erkektir. Nakil öncesi ortalama diyaliz süresi 83±59 aydır. Ortalama soğuk iskemi zamanı 12±3 saattir. Bir ve beş yıllık graft sağkalımı sırasıyla %94.4, %92.3; hasta sağkalımı %97.2, %89.9'dur. Hastaneden çıkış kreatinini yüksekliği (p=0.003) ve erken cerrahi komplikasyonların gelişimi (p=0.041) graft sağkalımını olumsuz etkileyen bağımsız risk faktörleridir. Alıcı yaşı≥46 olması (p=0.037) ve kardiyovasküler hastalık gelişimi (p=0.017) hasta kaybını artırmaktadır. Kardiyovasküler hastalık gelişimi hasta kaybı için bağımsız risk faktörüdür (HR=6,], p=0.041).SONUÇ: Çalışmada, kadaverik böbrek nakillerinde hastaneden çıkış kreatinini yüksekliği ve erken cerrahi komplikasyonların gelişiminin allograft kaybını, kardiyovasküler hastalık gelişminin hasta kaybını artırdığı gösterilmiştir.

show abstract

The impact of late acute rejection after cadaveric kidney transplantation

Cited by 76 publications

References 34 publications

Predictive Factors of Acute Rejection after Early Cyclosporine Withdrawal in Renal Transplant Recipients Who Receive Mycophenolate Mofetil

Predictive Factors of Acute Rejection after Early Cyclosporine Withdrawal in Renal Transplant Recipients Who Receive Mycophenolate Mofetil

Prospective Study on Late Consequences of Subclinical Non-Compliance with Immunosuppressive Therapy in Renal Transplant Patients

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey

Contact Info

Product

Resources

About

The impact of late acute rejection after cadaveric kidney transplantation

Cited by 76 publications

References 34 publications

Predictive Factors of Acute Rejection after Early Cyclosporine Withdrawal in Renal Transplant Recipients Who Receive Mycophenolate Mofetil

Predictive Factors of Acute Rejection after Early Cyclosporine Withdrawal in Renal Transplant Recipients Who Receive Mycophenolate Mofetil

Prospective Study on Late Consequences of Subclinical Non-Compliance with Immunosuppressive Therapy in Renal Transplant Patients

Factors Affecting Allograft and Patient Survival in Deceased Donor ￼Kidney Transplantation: A Single Center Experience in Turkey

Contact Info

Product

Resources

About

Factors Affecting Allograft and Patient Survival in Deceased Donor Kidney Transplantation: A Single Center Experience in Turkey