Risk factors for chronic rejection in renal allograft recipients
Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) we...
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| Veröffentlicht in: | Transplantation 1993-04, Vol.55 (4), p.752-6; discussion 756-7 |
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| creator | Almond, P S Matas, A Gillingham, K Dunn, D L Payne, W D Gores, P Gruessner, R Najarian, J S |
| description | Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P = .08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P < .0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (< 18 years, 18 to 50 years, > 50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (< 5 mg/kg vs. > or = 5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P < .001), CsA dosage < 5 mg/kg/day at 1 year (P = .007), infection (P = .023), female gender (P = .042), and retransplant (P = .103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage < 5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections). |
| doi_str_mv | 10.1097/00007890-199304000-00013 |
| format | Article |
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Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P = .08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P < .0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (< 18 years, 18 to 50 years, > 50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (< 5 mg/kg vs. > or = 5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P < .001), CsA dosage < 5 mg/kg/day at 1 year (P = .007), infection (P = .023), female gender (P = .042), and retransplant (P = .103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage < 5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections).]]></description><identifier>ISSN: 0041-1337</identifier><identifier>DOI: 10.1097/00007890-199304000-00013</identifier><identifier>PMID: 8475548</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Adult ; Aged ; Chronic Disease ; Cyclosporine - therapeutic use ; Female ; Graft Rejection - epidemiology ; Graft Rejection - etiology ; Graft Survival - drug effects ; Humans ; Kidney Transplantation - adverse effects ; Kidney Transplantation - immunology ; Male ; Middle Aged ; Regression Analysis ; Risk Factors ; Transplantation, Homologous</subject><ispartof>Transplantation, 1993-04, Vol.55 (4), p.752-6; discussion 756-7</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8475548$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Almond, P S</creatorcontrib><creatorcontrib>Matas, A</creatorcontrib><creatorcontrib>Gillingham, K</creatorcontrib><creatorcontrib>Dunn, D L</creatorcontrib><creatorcontrib>Payne, W D</creatorcontrib><creatorcontrib>Gores, P</creatorcontrib><creatorcontrib>Gruessner, R</creatorcontrib><creatorcontrib>Najarian, J S</creatorcontrib><title>Risk factors for chronic rejection in renal allograft recipients</title><title>Transplantation</title><addtitle>Transplantation</addtitle><description><![CDATA[Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P = .08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P < .0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (< 18 years, 18 to 50 years, > 50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (< 5 mg/kg vs. > or = 5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P < .001), CsA dosage < 5 mg/kg/day at 1 year (P = .007), infection (P = .023), female gender (P = .042), and retransplant (P = .103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage < 5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections).]]></description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Chronic Disease</subject><subject>Cyclosporine - therapeutic use</subject><subject>Female</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Rejection - etiology</subject><subject>Graft Survival - drug effects</subject><subject>Humans</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - immunology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Regression Analysis</subject><subject>Risk Factors</subject><subject>Transplantation, Homologous</subject><issn>0041-1337</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNotj09LxDAQxXNQ1nX1Iwg5easmnSaZ3JTFf7AgiJ5Lmk00a9vUpD347Q24A8PwG9483hBCObvhTKtbVkqhZhXXGlhTqCrN4YSsGWt4xQHUGTnP-VDWApRakRU2SogG1-TuLeRv6o2dY8rUx0TtV4pjsDS5g7NziCMNY4HR9NT0ffxMxs-FbZiCG-d8QU696bO7PM4N-Xh8eN8-V7vXp5ft_a6aaibnCmsAb7UCiyCMZBol-BJBic51smHokHclxh5ReC2l1AxVjZqjMEoZARty_e87pfizuDy3Q8jW9b0ZXVxyq0Q5qRGK8OooXLrB7dsphcGk3_b4MvwBJhtWvg</recordid><startdate>19930401</startdate><enddate>19930401</enddate><creator>Almond, P S</creator><creator>Matas, A</creator><creator>Gillingham, K</creator><creator>Dunn, D L</creator><creator>Payne, W D</creator><creator>Gores, P</creator><creator>Gruessner, R</creator><creator>Najarian, J S</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19930401</creationdate><title>Risk factors for chronic rejection in renal allograft recipients</title><author>Almond, P S ; Matas, A ; Gillingham, K ; Dunn, D L ; Payne, W D ; Gores, P ; Gruessner, R ; Najarian, J S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p206t-8233fc973c835a609863f55475beb6408e81bfacd885f96669087289185a77a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Chronic Disease</topic><topic>Cyclosporine - therapeutic use</topic><topic>Female</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Rejection - etiology</topic><topic>Graft Survival - drug effects</topic><topic>Humans</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - immunology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Regression Analysis</topic><topic>Risk Factors</topic><topic>Transplantation, Homologous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Almond, P S</creatorcontrib><creatorcontrib>Matas, A</creatorcontrib><creatorcontrib>Gillingham, K</creatorcontrib><creatorcontrib>Dunn, D L</creatorcontrib><creatorcontrib>Payne, W D</creatorcontrib><creatorcontrib>Gores, P</creatorcontrib><creatorcontrib>Gruessner, R</creatorcontrib><creatorcontrib>Najarian, J S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Almond, P S</au><au>Matas, A</au><au>Gillingham, K</au><au>Dunn, D L</au><au>Payne, W D</au><au>Gores, P</au><au>Gruessner, R</au><au>Najarian, J S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for chronic rejection in renal allograft recipients</atitle><jtitle>Transplantation</jtitle><addtitle>Transplantation</addtitle><date>1993-04-01</date><risdate>1993</risdate><volume>55</volume><issue>4</issue><spage>752</spage><epage>6; discussion 756-7</epage><pages>752-6; discussion 756-7</pages><issn>0041-1337</issn><abstract><![CDATA[Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing graft loss to acute rejection, has had little impact on the incidence of chronic rejection. Between June 2, 1986 and January 22, 1991, 587 kidney-alone transplants (566 patients) were performed, and had been entered into our renal transplant database and had at least 1 year of follow-up: 103 with biopsy-proven chronic rejection (37 living-related donor, 66 cadaver) and 484 without chronic rejection (236 LRD 248 CAD). The 5-year patient survival was 84% for recipients with biopsy-proven chronic rejection vs. 89% without (P = .08). The 5-year graft survival was 31% for recipients with biopsy-proven chronic rejection vs. 81% without (P < .0001). Using multivariate analysis, we determined the impact on the incidence of chronic rejection of these variables: transplant number, age at transplant (< 18 years, 18 to 50 years, > 50 years), gender, human leukocyte antigen matching, peak and transplant panel-reactive antibody, acute rejection episodes, infections (including cytomegalovirus, viral, and bacterial), donor age, and CsA dosage at 1 year (< 5 mg/kg vs. > or = 5 mg/kg). Logistic regression models were fit to the data using a forward stepwise selection procedure. In this analysis, risk factors included an acute rejection episode (P < .001), CsA dosage < 5 mg/kg/day at 1 year (P = .007), infection (P = .023), female gender (P = .042), and retransplant (P = .103). Individual analyses were done for CAD and LRD recipients. For both groups, important variables were acute rejection, infection, CsA dosage at 1 year, and age at transplant. In conclusion, acute rejection, CsA dosage < 5 mg/kg/day at 1 year, and infection are the major risk factors for the development of chronic rejection, suggesting that chronic rejection may be the result of inadequate immunosuppression (acute rejection episodes and low CsA dosage) or the production of inflammatory cytokines (infections).]]></abstract><cop>United States</cop><pmid>8475548</pmid><doi>10.1097/00007890-199304000-00013</doi></addata></record> |
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| source | Journals@Ovid Ovid Autoload; MEDLINE |
| subjects | Adolescent Adult Aged Chronic Disease Cyclosporine - therapeutic use Female Graft Rejection - epidemiology Graft Rejection - etiology Graft Survival - drug effects Humans Kidney Transplantation - adverse effects Kidney Transplantation - immunology Male Middle Aged Regression Analysis Risk Factors Transplantation, Homologous |
| title | Risk factors for chronic rejection in renal allograft recipients |
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