title: Reduction in acute rejections decreases chronic rejection graft failure in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS).
abstract: Chronic rejection accounted for 32% of all graft losses in 7123 pediatric transplants. In a previous study acute, multiple acute and late acute rejections were risk factors for the development of chronic rejection. We postulated that the recent decrease in acute rejections would translate into a lower risk for chronic rejection among patients with recent transplants. We reviewed our data on patients transplanted from 1995 to 2000, and using multivariate analysis and a proportional hazards model developed risk factors for patients whose grafts had failed due to chronic rejection. A late initial rejection increased the risk of chronic rejection graft failure 3.6-fold (p < 0.001), while a second rejection resulted in further increase of 4.2-fold (p < 0.001). Recipients who received less than 5 mg/kg of cyclosporine at 30 days post-transplant had a relative risk (RR) of 1.9 (p = 0.02). Patients transplanted from 1995 to 2000 had a significantly lower risk (RR = 0.54, p < 0.001) of graft failure from chronic rejection than those who received their transplants earlier (1987-94). Since we were able to demonstrate that there is a decreased risk of chronic rejection graft failure in our study cohort, we would conclude that the goal of future transplants should be to minimize acute rejections.
authors.affiliation: Department of Pediatrics and Surgery, New York Medical College, Valhalla, USA. Atejani@aol.com
authors.forename: Amir
authors.initials: A
authors.lastname: Tejani
authors.forename: Ping Leung
authors.initials: PL
authors.lastname: Ho
authors.forename: Lea
authors.initials: L
authors.lastname: Emmett
authors.forename: Donald M
authors.initials: DM
authors.lastname: Stablein
mesh_terms: D000208:Acute Disease; D000704:Analysis of Variance; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D044469:Racial Groups; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D017211:Treatment Failure