title: Why do kidney grafts fail?A long-term single-center experience.
abstract: Chronic allograft failure remains the main problem limiting long-term success after kidney transplantation. The aim of this retrospective analysis was to define clinical and histological parameters associated with favorable or poor 10-year outcome. To compare outcome we defined two groups of cadaveric-allograft recipients: a good-outcome group (GOG), composed of 145 cadaveric-kidney recipients who had lived with a functioning graft for at least 10 years and who were either still alive or had died with the functioning graft, and a poor-outcome group (POG) consisting of 86 cadaveric-kidney recipients who had had a functioning graft for at least 1 year and had returned to dialysis between 1 and 10 years after transplantation. The following factors were found to be statistically significant indicators of poor outcome: advanced donor age ( P=0.0001); a first biopsy-proven acute rejection episode within the 1st year ( P<0.0001); more than one acute rejection episode within the 1st year ( P<0.0001); acute vascular rejection, especially if occurring after the 3rd month ( P<0.0001); chronic sclerosing rejection ( P<0.0001); glomerulonephritis in the graft ( P=0.0001); and non-compliance and suboptimal medical treatment (15% of the POG). The mean plasma creatinine and mean urine protein-to-creatinine ratios were significantly lower at 1 month and 1 year in the GOG. In conclusion, advanced donor age, acute rejection episodes with vascular involvement, chronic sclerosing rejection, non-compliance, and suboptimal medical treatment are strong predictors of a poor long-term outcome. The plasma creatinine and protein-to-creatinine ratios at 1 year are the best predictors of good or poor long-term outcome.
authors.affiliation: Division of Transplantation Immunology and Nephrology, Department of Internal Medicine, University Hospital of Basle, Petersgraben 4, 4031 Basle, Switzerland. mdickenmann@uhbs.ch
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dickenmann
authors.forename: Volker
authors.initials: V
authors.lastname: Nickeleit
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsinalis
authors.forename: Lorenz
authors.initials: L
authors.lastname: Gürke
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mihatsch
authors.forename: Gilbert
authors.initials: G
authors.lastname: Thiel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000276:immunology / Q000473:pathology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000276:immunology; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D007518:Isoantibodies