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Both acute rejection and the function of a renal allograft early after transplantation correlate with long-term graft survival. In this study we assessed the relationship between these two factors in 843 adult recipients of first cadaveric renal grafts, transplanted at a single institution and followed for a minimum of 3.5 years. Patients were divided into four groups according to (1) history of acute rejection (AR) during the first 6 months after transplantation, and (2) concentration of serum creatinine at 6 months after transplantation (SCr(6mo) < or > or = 2 mg/dl). Death censored allograft survival was not significantly different among patients without AR and with low SCr(6mo) (group 1, n=376), patients without AR but with an elevated SCr(6mo) (group 2, n=117), and patients with AR but low SCr(6mo) (group 3, n=185). In contrast, graft survival was significantly worse in patients with AR and an elevated SCr(6mo) (group 4, n=165) compared with patients in the other three groups (Cox, P<0.0001). The elevated SCr(6mo) in group 4 patients was not necessarily the consequence of AR, as 32% of patients in group 4 had a SCr at 10 days after transplantation (SCr(10d)), before they had AR, that was equal to or higher than the SCr(6mo). Based on this observation we investigated the implications of the SCr(10d) concentration for graft prognosis. The SCr(10d) correlated weakly with graft survival (Cox, P=0.05). However, an elevated SCr(10d) correlated with other potential risk factors for graft survival including: Older donors (P<0.0001), male recipients (P<0.0001), and heavier recipients (P<0.0001, all by multivariate regression); and posttransplant factors such as, increasing numbers of AR (P<0.0001), higher posttransplant blood pressure (P<0.0001), and lower doses of cyclosporine (P<0.0001, all by multivariate regression). In conclusion, graft dysfunction predicts poor graft survival only when associated with AR. Similarly, AR predicts a poor renal allograft survival only when associated with graft dysfunction. The SCr(10d) is an indicator of risk factors from both the donor and recipient, and an elevated SCr(10d) predicts a higher risk of acquiring additional risk factors early after transplantation.
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
May 1993,
Transplantation,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
November 2003,
Chinese medical journal,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
December 1996,
Clinical transplantation,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
July 1996,
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
April 1996,
Clinical transplantation,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
December 2004,
Journal of the American Society of Nephrology : JASN,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
March 1994,
Transplantation,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
December 1997,
Clinical transplantation,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
March 1999,
Surgery,
F G Cosio, and
R P Pelletier, and
M E Falkenhain, and
M L Henry, and
E A Elkhammas, and
E A Davies, and
G L Bumgardner, and
R M Ferguson
September 2015,
Kidney research and clinical practice,
