Acute rejection episodes after kidney transplantation.
Acute rejection episodes (AREs) are a major determinant of renal allograft survival. The incorporation of new immunosuppressive agents explains, at least partially, the improvement seen in the results of transplantation in recent years. The objectives of this study are to analyze the incidence and severity of AREs, their risk factors and their influence on graft and patient survival. We retrospectively studied 280 kidney transplants performed in adults at the Charles Nicolle Hospital, Tunis, between 1986 and 2004. The diagnosis of ARE was based on clinical data and response to treatment. Allograft biopsies were performed in ten cases. The treatment of AREs consisted of pulse methylprednisolone and anti-thymocyte globulin. There were 186 males (66.4%) and 94 females (33.6%), and their mean age was 31 +/- 8.9 years. Overall, the 280 study patients experienced a total of 113 AREs. Of them, 85 had only one ARE, 28 had two to three and none had more than three AREs. A total of 68 AREs were completely re-versible, 42 were partially reversible while three could not be reversed with treatment. The mean inci-dence of AREs was 40.4%. The incidence was > 45% between 1986 and 1997, decreased to 20.5% between 1998 and 2000 and to 9% between 2001 and 2004. Graft survival rates in patients with and without AREs were respectively 91% and 93% at three years, 82% and 90% at five years and 73% and 83% at 10 years. We found a decrease in the incidence of AREs in recent years in our study patients, and this was related to the introduction of sensitized cross-match and the newer immunosuppressive agents, particularly MMF. Additionally, AREs had a deleterious impact on late graft survival in our study population.
Department of Nephrology, Charles Nicolle Hospital, Tunis, Tunisia. fethi.hamida@rns.tn
Fethi Ben
FB
Hamida
Samia
S
Barbouch
Rafika
R
Bardi
Imed
I
Helal
Hayet
H
Kaaroud
Lilia Ben
LB
Fatma
Hafedh
H
Hedri
Ezzeddine
E
Abderrahim
Taieb Ben
TB
Abdallah
Khaled
K
Ayed
Hedi Ben
HB
Maiz
Adel
A
Kheder
D000208:Acute Disease; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D006085:Graft Survival / Q000187:drug effects; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology; D055815:Young Adult
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D008775:Methylprednisolone