The impact of early and late acute rejection on graft survival in renal transplantation
Background: Advances in immunosuppression after kidney transplantation have decreased the influence of early acute rejection (EAR) on graft survival. Several studies have suggested that late acute rejection (LAR) has a poorer effect on long-term graft survival than EAR. We investigated whether the t...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
The Korean Society of Nephrology
2015-09-01
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| Series: | Kidney Research and Clinical Practice |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211913215300036 |
| _version_ | 1811256605741678592 |
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| author | Eun Hee Koo Hye Ryoun Jang Jung Eun Lee Jae Berm Park Sung-Joo Kim Dae Joong Kim Yoon-Goo Kim Ha Young Oh Wooseong Huh |
| author_facet | Eun Hee Koo Hye Ryoun Jang Jung Eun Lee Jae Berm Park Sung-Joo Kim Dae Joong Kim Yoon-Goo Kim Ha Young Oh Wooseong Huh |
| author_sort | Eun Hee Koo |
| collection | DOAJ |
| description | Background: Advances in immunosuppression after kidney transplantation have decreased the influence of early acute rejection (EAR) on graft survival. Several studies have suggested that late acute rejection (LAR) has a poorer effect on long-term graft survival than EAR. We investigated whether the timing of acute rejection (AR) influences graft survival, and analyzed the risk factors for EAR and LAR.
Methods: We performed a retrospective cohort study involving 709 patients who underwent kidney transplantation between 2000 and 2009 at the Samsung Medical Center, Seoul, Korea. Patients were divided into three groups: no AR, EAR, and LAR. EAR and LAR were defined as rejection before 1 year and after 1 year, respectively. Differences in graft survival between the three groups and risk factors of graft failure were analyzed.
Results: Of the 709 patients, 198 (30%) had biopsy-proven AR [EAR=152 patients (77%); LAR=46 patients (23%)]. A total of 65 transplants were lost. The 5-year graft survival rates were 97%, 89%, and 85% for patients with no AR, EAR, and LAR, respectively. These differences were significant (P<0.001 for both by log-rank test). In time-dependent Cox regression analysis, EAR (hazards ratio, 3.37; 95% confidence interval, 1.90–5.99) and LAR (hazards ratio, 5.32; 95% confidence interval, 2.65–10.69) were significantly related to graft failure. When we set LAR as standard and compared it with EAR, there was no statistical difference between EAR and LAR (P=0.21).
Conclusion: AR, regardless of its timing, significantly worsened graft survival. Treatments to reduce the incidence of AR and improve prognosis are needed. |
| first_indexed | 2024-04-12T17:42:49Z |
| format | Article |
| id | doaj.art-e6b8e058f85740d89966c1f98cc50be8 |
| institution | Directory Open Access Journal |
| issn | 2211-9132 |
| language | English |
| last_indexed | 2024-04-12T17:42:49Z |
| publishDate | 2015-09-01 |
| publisher | The Korean Society of Nephrology |
| record_format | Article |
| series | Kidney Research and Clinical Practice |
| spelling | doaj.art-e6b8e058f85740d89966c1f98cc50be82022-12-22T03:22:45ZengThe Korean Society of NephrologyKidney Research and Clinical Practice2211-91322015-09-0134316016410.1016/j.krcp.2015.06.003The impact of early and late acute rejection on graft survival in renal transplantationEun Hee Koo0Hye Ryoun Jang1Jung Eun Lee2Jae Berm Park3Sung-Joo Kim4Dae Joong Kim5Yoon-Goo Kim6Ha Young Oh7Wooseong Huh8Nephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaNephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaNephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaNephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaNephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaNephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaNephrology Division, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, KoreaBackground: Advances in immunosuppression after kidney transplantation have decreased the influence of early acute rejection (EAR) on graft survival. Several studies have suggested that late acute rejection (LAR) has a poorer effect on long-term graft survival than EAR. We investigated whether the timing of acute rejection (AR) influences graft survival, and analyzed the risk factors for EAR and LAR. Methods: We performed a retrospective cohort study involving 709 patients who underwent kidney transplantation between 2000 and 2009 at the Samsung Medical Center, Seoul, Korea. Patients were divided into three groups: no AR, EAR, and LAR. EAR and LAR were defined as rejection before 1 year and after 1 year, respectively. Differences in graft survival between the three groups and risk factors of graft failure were analyzed. Results: Of the 709 patients, 198 (30%) had biopsy-proven AR [EAR=152 patients (77%); LAR=46 patients (23%)]. A total of 65 transplants were lost. The 5-year graft survival rates were 97%, 89%, and 85% for patients with no AR, EAR, and LAR, respectively. These differences were significant (P<0.001 for both by log-rank test). In time-dependent Cox regression analysis, EAR (hazards ratio, 3.37; 95% confidence interval, 1.90–5.99) and LAR (hazards ratio, 5.32; 95% confidence interval, 2.65–10.69) were significantly related to graft failure. When we set LAR as standard and compared it with EAR, there was no statistical difference between EAR and LAR (P=0.21). Conclusion: AR, regardless of its timing, significantly worsened graft survival. Treatments to reduce the incidence of AR and improve prognosis are needed.http://www.sciencedirect.com/science/article/pii/S2211913215300036Acute rejectionGraft survivalKidney transplantation |
| spellingShingle | Eun Hee Koo Hye Ryoun Jang Jung Eun Lee Jae Berm Park Sung-Joo Kim Dae Joong Kim Yoon-Goo Kim Ha Young Oh Wooseong Huh The impact of early and late acute rejection on graft survival in renal transplantation Kidney Research and Clinical Practice Acute rejection Graft survival Kidney transplantation |
| title | The impact of early and late acute rejection on graft survival in renal transplantation |
| title_full | The impact of early and late acute rejection on graft survival in renal transplantation |
| title_fullStr | The impact of early and late acute rejection on graft survival in renal transplantation |
| title_full_unstemmed | The impact of early and late acute rejection on graft survival in renal transplantation |
| title_short | The impact of early and late acute rejection on graft survival in renal transplantation |
| title_sort | impact of early and late acute rejection on graft survival in renal transplantation |
| topic | Acute rejection Graft survival Kidney transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S2211913215300036 |
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