[From acute to chronic rejection after kidney transplantation].
BACKGROUND
Increased frequency of acute rejection episodes is the best predictor for the development of an chonic rejection process in kidney transplantation. An effective antirejection therapy is critical to prevent transplant failure due to chronic rejection.


OBJECTIVE
The relationship between acute and chronic rejection is determined by the number of rejection episodes, clinical and histological grading, timing, residual function and individual problems of donor and recipient.


METHODS
Standard immunosuppression with calcineurin inhibitors such as cyclosporine or tacrolimus and antiproliferative substances such as azathioprine or mycophenolatemofetile have to be intensified when an acute rejection episode occurs. For maximal immunosuppression antibody preparations such as ATG and OKT3 in combination with with a short course of steroid pulse therapy are available.


CONCLUSIONS
In this review we summarize the clinical implications and therapeutic consequences of the relationship between acute and chronic rejection. The acute rejection episode has still a great impact on long-term graft outcome which may only be improved by a prompt treatment of initial acute rejection episodes.
Arns
Wolfgang
W
Medizinische Klinik I, Kliniken der Stadt Köln, Germany. wolfgang.ams@uni-koeln.de
Weber
Manfred
M
D000208:Acute Disease; D002908:Chronic Disease; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology*; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*
D007166:Immunosuppressive Agents