Chronic allograft failure in human renal transplantation: a multivariate risk factor analysis.
OBJECTIVE
To identify potential risk factors for the development of chronic renal allograft failure.


BACKGROUND
Chronic allograft failure (CAF) is the leading cause of late graft loss in renal transplantation. The authors studied the risk factors for the development of CAF in a single center during a period in which a consistent baseline immunosuppression regimen (cyclosporine, azathioprine, and prednisolone) was used.


METHODS
Data from the Oxford Transplant Center Database were assessed on 862 renal allografts during a 10-year period. Risk factors were identified using multivariate logistic regression analysis.


RESULTS
Biopsy-proven CAF occurred in 77 patients (9.2%) in the entire group. Multivariate risk factor analysis revealed that early and late acute rejection episodes, proteinuria, and serum triglycerides were significant factors. Acute rejection after 3 months was more important than early acute rejection. Serum triglyceride level and proteinuria at 1 year were both elevated in the CAF group. Male sex provided a protective effect. Serum creatinine levels at 6 months after the transplant were not predictive of the risk of developing CAF.


CONCLUSIONS
These results from the largest single-center review to date suggest that both antigen-dependent and -independent factors are involved in the pathogenesis of CAF. Acute rejection at all time points has a significant impact on the development of CAF.
McLaren
A J
AJ
Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom.
Fuggle
S V
SV
Welsh
K I
KI
Gray
D W
DW
Morris
P J
PJ
D000328:Adult; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014280:Triglycerides / Q000097:blood
D014280:Triglycerides; D003404:Creatinine