The impact of acute rejection in kidney transplantation on long-term allograft and patient outcome.
BACKGROUND
Patients with end stage renal disease (ESRD) can be sustained with dialysis therapy.


OBJECTIVE
In this study, we followed up the effect of early acute and late acute rejections on survival rates of patients' grafts.


METHODS
We investigated the timing and frequency of acute rejection episodes related to long-term patient-graft survival in Taleghani hospital between 1990 and 2011. Recipients were divided into three groups as Group-1 (no rejection), Group-2 (early acute rejection [EAR]: less than 3-months) and Group-3 (late acute rejection [LAR]: after 3 months of transplant).


RESULTS
One and five-year patient's survival rates were 94.87% and 93.8%, and graft survival (GS) rates were 92.6% and 81.9%. EAR and LAR occurred in 125 (18.8%) and 77 (11.7%) patients, respectively. Graft and patient survival rates at one and five years were as follows; Group-1 (Graft 96.7% and 94.5% patient: 97.4% and 96.8%), Group-2 (Graft: 72% and 61%, patient: 85.6% and 84%), Group-3 (Graft: 84.4% and 36.8%, patient: 92.2% and 89.4%). Recipient age, type and length of dialysis, number of transplantations and the status of panel reactivity antibody (PRA) had no effect on the type of rejection. LAR was more commonly associated with males (P = 0.001) and donors' age was associated with rejection (P = 0.0002). Five-year GS rate among the three groups was lower in the LAR group (P < 0.0001).


CONCLUSIONS
LAR had a negative impact on long-term renal allograft survival and the risk of chronic graft dysfunction increased in patients with a history of LAR.
Department of Nephrology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Mojgan
M
Jalalzadeh
Department of Social Medicine, Zanjan University of Medical Sciences, Zanjan, IR Iran.
Nouraddin
N
Mousavinasab
Maraghe University of Medical Sciences, Maraghe, IR Iran.
Said
S
Peyrovi
Department of Nephrology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Mohammad Hassan
MH
Ghadiani
Graft Survival; Kidney Transplantation; Rejection; Survival