title: Five-year results of kidney transplantation under tacrolimus-based regimes: the persisting significance of vascular rejection.
abstract: BACKGROUND
  Acute rejection has been the major risk factor for medium-term kidney graft loss because of chronic allograft nephropathy. We investigated whether the use of improved immunosuppression has altered the relationship between acute and chronic rejection by analyzing data from 245 renal transplant patients receiving Tacrolimus-based immunosuppression.
  
  
  RESULTS
  Five-year graft survival (censored for death with functioning graft) was 88.8% with no significant difference between living and cadaveric kidney transplants. The only significant predictor of medium-term graft loss was acute vascular rejection.
  
  
  CONCLUSIONS
  Under Tacrolimus-based immunosuppression, the occurrence of acute interstitial rejection, even when occurring late, repeatedly, or with failure of graft function to return to baseline, was not associated with chronic allograft nephropathy or medium-term graft loss. Vascular rejection remains the major immunological obstacle to long-term transplant success. Five-year overall survival rates with a functioning graft of 80% with 90% graft survival censored for death with function seem to be realistic and achievable goals.
authors.affiliation: Renal and Transplant Unit, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom. mloucaidou@doctors.net.uk.
authors.forename: M
authors.initials: M
authors.lastname: Loucaidou
authors.forename: A G
authors.initials: AG
authors.lastname: McLean
authors.forename: T D H
authors.initials: TD
authors.lastname: Cairns
authors.forename: M
authors.initials: M
authors.lastname: Griffith
authors.forename: N
authors.initials: N
authors.lastname: Hakim
authors.forename: A
authors.initials: A
authors.lastname: Palmer
authors.forename: V
authors.initials: V
authors.lastname: Papalois
authors.forename: J
authors.initials: J
authors.lastname: Van Tromp
authors.forename: C
authors.initials: C
authors.lastname: Loucaides
authors.forename: K I
authors.initials: KI
authors.lastname: Welsh
authors.forename: D
authors.initials: D
authors.lastname: Taube
mesh_terms: D000328:Adult; D001808:Blood Vessels / Q000503:physiopathology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation; D008297:Male; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus