title: Risk factors for steroid-resistant T-cell-mediated acute cellular rejection and their effect on kidney graft and patient outcome.
abstract: OBJECTIVE
  Acute rejection in renal transplant is considered a risk factor for short-term and long-term allograft survival. The expected reversal rate for the first acute cellular rejection, by steroid pulse, ranges between 60% and 100%, and lack of improvement within 1 week of treatment is defined as steroid-resistant rejection. This work sought to evaluate factors that lead to steroid-resistant acute cellular rejection among patients with first live-donor renal allotransplant and its effect on graft and patient survival.
  
  
  METHODS
  Patients with an improvement in serum creatinine levels were considered controls (group 1; n=100); while the others were considered an early steroid-resistant group (group 2; n=99). Both groups were matched demographically.
  
  
  RESULTS
  Patients with a target cyclosporine level below accepted therapeutic levels were significantly higher in group 2 (P = .02). We found no significant differences between the groups regarding posttransplant complications (P > .05). Mean hospital stay was longer in group 2 (P = .021). Living patients with functioning graft were more prevalent in group 1, while those alive on dialysis were more prevalent in group 2. The groups were comparable regarding long-term patient and graft survival despite significantly lower creatinine values in patients of group 1 at 6 months' follow-up (P ≤ .001).
  
  
  CONCLUSIONS
  Prebiopsy low cyclosporine trough levels and associated chronic changes among patients who were maintained on calcineurin inhibitor-based regimens represented the most-important risk factors for the early steroid-resistant group. Rescue therapies improve short-term graft outcome; however, they did not affect either patient or long-term graft survival after 5 years' follow-up.
authors.affiliation: Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Awadain
authors.forename: Osama
authors.initials: O
authors.lastname: Gheith
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hassan
authors.forename: Nabil
authors.initials: N
authors.lastname: Hassan
authors.forename: Salem
authors.initials: S
authors.lastname: El-Deeb
authors.forename: Amjad
authors.initials: A
authors.lastname: el-Agroudy
authors.forename: Ashraf
authors.initials: A
authors.lastname: Fouda
authors.forename: Mohamed Ahmed
authors.initials: MA
authors.lastname: Ghoneim
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage; D004351:Drug Resistance / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D013601:T-Lymphocytes / Q000276:immunology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D016572:Cyclosporine; D003404:Creatinine