title: Risk factors for acute rejection in renal transplant recipients experiencing delayed graft function.
abstract: Acute rejection (AR) superimposed upon delayed graft function (DGF) following renal transplantation worsens graft outcomes. However, risk factors for AR in patients displaying DGF remain unclear. In this study, 71 patients displaying DGF >/= 5 d were investigated. All received cyclosporine, adjunctive azathioprine or mycophenolate mofetil (MMF), and corticosteroids, with 43 receiving anti-CD25 monoclonal antibody induction. AR episodes were seen in 20 of 71 (28%) patients. Higher C2 levels at days 3 and 5 and the use of MMF were associated with a reduced incidence of AR, with increased HLA-DR mismatch associated with an increased risk for AR. C2 levels at days 3 and 5 below 885 and 1096 ng/mL, respectively, showed best discriminatory values for AR. C2 levels showed no correlation with DGF duration. This study suggests that optimizing immunosuppression in patients with DGF (by ensuring adequate calcineurin inhibitor exposure and the use of potent adjunctive immunosuppression) may reduce the incidence of AR without prolonging the duration of dialysis requirement.
authors.affiliation: Department of Renal Transplantation, University Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Jason
authors.initials: J
authors.lastname: Moore
authors.forename: Kay
authors.initials: K
authors.lastname: Tan
authors.forename: Paul
authors.initials: P
authors.lastname: Cockwell
authors.forename: Hari
authors.initials: H
authors.lastname: Krishnan
authors.forename: Dawn
authors.initials: D
authors.lastname: McPake
authors.forename: Andrew
authors.initials: A
authors.lastname: Ready
authors.forename: Steve
authors.initials: S
authors.lastname: Mellor
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hamsho
authors.forename: Simon
authors.initials: S
authors.lastname: Ball
authors.forename: Graham
authors.initials: G
authors.lastname: Lipkin
authors.forename: Richard
authors.initials: R
authors.lastname: Borrows
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D065095:Calcineurin Inhibitors; D016022:Case-Control Studies; D003175:Complement C2 / Q000032:analysis / Q000276:immunology; D051799:Delayed Graft Function / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D065095:Calcineurin Inhibitors; D003175:Complement C2; D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents