Causes of late renal allograft failure in the ciclosporin era.
A single center experience of 514 ciclosporin-treated renal allografts which survived longer than 1 year was reviewed in order to analyze the causes of renal allograft loss beyond the 1st year post-transplantation and the contribution of selected parameters to long-term survival. 83 grafts were lost between 1 and 5 years with the most common causes of graft loss being chronic rejection (54%), death (14%), noncompliance (13%) and sepsis (11%). Actuarial 5-year graft survival rates, decaying from 100% at 1 year, of living related and cadaveric grafts were 88.6 and 79.5%, respectively. Parameters with a substantial influence on long-term survival included the quality of early graft function and incidence of acute rejection in the 1st year post-transplantation. A marker for long-term survival (> 5 years) was a significantly lower serum creatinine (177 mumol/l; < or = 2 mg/dl) at 1 year. We conclude that chronic rejection is responsible for the majority of late graft losses in the ciclosporin era as in the earlier azathioprine period.
Hong
J H
JH
Department of Surgery, State University of New York, Brooklyn 11203.
Sumrani
N
N
Delaney
V
V
Davis
R
R
Dibenedetto
A
A
Butt
K M
KM
D000328:Adult; D003141:Communicable Diseases / Q000150:complications; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D008297:Male; D010349:Patient Compliance; D013997:Time Factors
D016572:Cyclosporine