title: Decreased acute rejection in kidney transplant recipients is associated with decreased chronic rejection.
abstract: OBJECTIVE
  To determine whether a recent decrease in the rate of acute rejection after kidney transplantation was associated with a decrease in the rate of chronic rejection.
  
  
  BACKGROUND
  Single-institution and multicenter retrospective analyses have identified acute rejection episodes as the major risk factor for chronic rejection after kidney transplantation. However, to date, no study has shown that a decrease in the rate of acute rejection leads to a decrease in the rate of chronic rejection.
  
  
  METHODS
  The authors studied patient populations who underwent transplants at a single center during two eras (1984-1987 and 1991-1994) to determine the rate of biopsy-proven acute rejection, the rate of biopsy-proven chronic rejection, and the graft half-life.
  
  
  RESULTS
  Recipients who underwent transplantation in era 2 had a decreased rate of biopsy-proven acute rejection compared with era 1 (p < 0.05). This decrease was associated with a decreased rate of biopsy-proven chronic rejection for both cadaver (p = 0.0001) and living donor (p = 0.08) recipients. A trend was observed toward increased graft half-life in era 2 (p = NS).
  
  
  CONCLUSIONS
  Development of immunosuppressive protocols that decrease the rate of acute rejection should lower the rate of chronic rejection and improve long-term graft survival.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Matas
authors.forename: A
authors.initials: A
authors.lastname: Humar
authors.forename: W D
authors.initials: WD
authors.lastname: Payne
authors.forename: K J
authors.initials: KJ
authors.lastname: Gillingham
authors.forename: D L
authors.initials: DL
authors.lastname: Dunn
authors.forename: D E
authors.initials: DE
authors.lastname: Sutherland
authors.forename: J S
authors.initials: JS
authors.lastname: Najarian
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D016030:Kidney Transplantation; D012189:Retrospective Studies