title: Cell-mediated and humoral acute vascular rejection and graft loss: A registry study.
abstract: OBJECTIVE
  Rejection of renal allografts following transplantation continues to be a major impediment to long-term graft survival. Although acute vascular rejection (AVR) is associated with a high risk of graft loss, it remains unclear whether AVR with accompanied cellular or acute humoral rejection (AHR) have dissimilar outcomes. The aim of this registry study was to examine the association between subtypes of AVR and graft loss.
  
  
  METHODS
  Using Australia and New Zealand Dialysis and Transplant registry, primary kidney transplant recipients between 2005 and 2012 whose first rejection episode was AVR were included and categorized into AVR-none (AVR without other rejections), AVR-CG (AVR with cellular and/or glomerular rejections), and AVR-AHR (AVR with AHR). Association between AVR groups and graft loss was examined using logistic and Cox regression models.
  
  
  RESULTS
  Of the 274 recipients, 61 (22.3%) experienced AVR-none, 79 (28.8%) AVR-AHR and 134 (48.9%) AVR-CG. Compared with AVR-none and AVR-CG, AVR-AHR was associated with the highest incidence of overall graft loss at 3 months (12%, 10% and 27%, respectively, χ(2) = 11.88, P = 0.003). AVR-AHR was associated with almost a threefold greater risk of death-censored graft loss compared with AVR-none (adjusted hazard ratio 2.84, 95% confidence interval 1.22-2.62, P < 0.01).
  
  
  CONCLUSIONS
  AVR-AHR is associated with the poorest outcome with over 25% of grafts being lost 3 months after transplantation. Future studies evaluating factors that predict graft loss in AVR-AHR may help determine prognosis and inform treatment practices.
authors.affiliation: Renal Unit, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Rachel Z C
authors.initials: RZ
authors.lastname: Teo
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia.|Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.|ANZDATA Registry, Adelaide, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Russ
authors.affiliation: ANZDATA Registry, Adelaide, Australia.|Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
mesh_terms: D000328:Adult; D064591:Allografts; D001315:Australia; D016009:Chi-Square Distribution; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology*; D006085:Graft Survival; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000276:immunology*
keywords: ANZDATA registry; graft loss; humoral rejection; kidney transplant; vascular rejection