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J M Cecka

Publications and source records attributed to J M Cecka.

At least 73 records · Page 4Linked to original sources
PubMed1995

The effect of race and ethnicity on kidney allograft outcome.

Asian recipients of cadaveric renal allografts had the best long-term survival rates. Five-year graft survival rates were 66% for 1,713 Asians, 61% for 4,722 Hispanics and 33,190 Whites, and 47% for 12,948 Blacks. This trend had already been established at one-year posttransplant. Transplant half-lives calculated after 6 months were 12 years for Asians, 10 years for Whites, 9 years for Hispanics and 5 years for Blacks. These have all improved over the last 4 years. Part of the explanation for the outstanding half-life for Asian recipients is the 15 year half-life of the 672 Asian females reported. The superior graft survival for Asian recipients may be due in part to the low incidence of sensitization, the low incidence of acute rejection and chronic rejection leading to graft loss, and the high prevalence of primary disease entities that have been associated with excellent long-term prognoses, especially IgA nephropathy and chronic glomerulonephritis. Hispanic recipients also had excellent short- and long-term graft survival rates. This may be due to having the lowest incidence of early acute rejection episodes compared with all other racial groups, and the limited deleterious effect of ATN on long-term graft survival among Hispanics. The poor overall graft survival for Black recipients may be due to poor HLA matching, a high rate of sensitization and a grim effect of sensitization on graft survival, the high incidences of acute rejection and ATN, and the high incidence of HTN both pre- and posttransplant. The only subgroups of Black recipients who had graft survival rates that were comparable to other racial groups were the zero-HLA-mismatched Black recipients and those Black recipients over age 65. Long-term patient survival rates were the best for Asians and Hispanics (89% and 90% at 5 years, respectively). The 5-year patient survival rates were lower for Blacks and Whites (86% each). There was no difference in patient survival at one-year posttransplant (95-96% for each group). A higher proportion of White diabetic recipients received simultaneous SPK transplants (31%) than Black (10%), Hispanic (11%) or Asian (7%) diabetics. The reasons for this disparity are unclear. However, SPK transplants improved 5-year kidney graft survival for Whites (67% vs 55% in patients receiving kidneys alone), but were not associated with improved 5-year kidney survival among non-Whites. White donors accounted for the majority of all transplanted organs (79%). Matching donor and recipient race ("race matching") led to better long-term allograft survival for White recipients only. There was no donor-recipient "race matching" effect for minority groups.

Adolescent↗
PubMed1995

Primary disease effects and associations in patients without early posttransplant events.

Many patients receiving primary cadaver renal transplants have complications in their early post-transplant courses which can affect and possibly confound long-term outcome analyses. Forty-four percent of primary cadaver recipients in the present study were excluded because of early events: delayed graft function (DGF) and early rejection episodes (ERE). Even with these exclusions, similar conclusions to the previous study (1) were noted: that is, the patients with systemic diseases (NS, HTN and IDDM) had the lowest 5-year graft survivals (57-62%) compared to those with diseases that were primarily renal (ALP, IGA and PC) which had better 5-year graft survival results (76-81%). Long-term half-life calculations also demonstrated improved graft survival prognoses in patients with primarily renal diseases (15-18 years in ALP, IGA and PC vs 6-8 years in IDDM, HTN and NS). Again, with the exclusions of patients with early events, Black recipients with HTN did not fare as well as non-Blacks (5-year graft survival of only 52% vs 69%). Many long-term graft losses were due to deaths, oftentimes from cardiovascular diseases. This was especially prominent in disease states with the greatest potential for arteriosclerosis (IDDM, HTN and NS). When patients with early events were excluded, the percent of graft losses attributable to patient death ranged from 21-58%, but were the highest with HTN, PC (age related) and IDDM: 41%, 45% and 58%. A similar analysis in IDDM patients receiving either a LD, SPK or KAT-type transplant revealed that although there was a 10% reduction in 5-year graft survival for KAT patients, most of these graft losses were owing to patient death. Outcomes in SPK and LD in IDDM patients were similar, suggesting selection bias and center effects with the latter two types of transplants going to healthier IDDM patients. It is too soon to conclude whether FK506 has a particularly beneficial role in one primary disease or another as compared to CsA. Combined kidney transplantation with a liver or heart transplant appears to be a reasonable risk. When graft losses due to patient deaths are accounted for, kidney graft survival was approximately that of kidney alone transplantation, suggesting again that graft loss due to patient death must be accounted for when analyzing transplant graft survival.

Graft Survival↗
PubMed1995

New variables reported to the UNOS registry and their impact on cadaveric renal transplant outcomes - a preliminary study.

Several new factors collected by UNOS since 1994 were examined with regard to their effects on early graft function and 6-month graft survival in this study. Medicare patients had a lower 6-month graft survival rate than private insurance patients, though the difference was not statistically significant. Medicaid patients had a significantly lower graft survival rate than private insurance patients (p=0.04). Blacks had the same graft survival as Whites when they had comparable coverage. Both Blacks and Whites had higher graft survival with private insurance and lower survival with government funding. Non-heartbeating cadaver-donor kidneys yielded a lower graft survival rate than heartbeating donors (p=0.03). Experience with non-heartbeating donors is just beginning with only 89 kidneys compared with 8,766 heartbeating donor kidneys. Kidneys from donors with hypertension resulted in lower graft survival rates than those from donors without hypertension (p=0.01). In these preliminary studies, donor history of diabetes, smoking, alcohol dependency, I.V. drug use and cancer did not have a significant impact on graft survival. Patients who had a high body mass index (>26) had a lower 6-month graft survival rate (p=0.009). Patients who received kidneys from cadaver donors with a low body mass index (<20) had a lower 6-month graft survival rate (p=0.02). When the recipient was more than 30 kg heavier than the donor, a lower 6-month graft survival rate was obtained (p=0.007). When the weight ratio was greater than 2.0, again a lower survival was noted (p<0.001). A recipient-to-donor height ratio of more than 1.25 resulted in an 80% 6-month graft survival which was significantly less than the 87% survival rate among those with a ratio less than 1.25 (p<0.001). This cut-off was found to identify patients with the lowest 6-month survival rate, suggesting that donor-recipient pairs with a height ratio above 1.25 should not be transplanted. A 6-month graft survival rate of 90% was reported with a SMI of 16-20, where SMI = weight of recipient divided by the square of the donor height. From this preliminary study, the SMI appears to be the best predictor of high graft survival since 1,450 patients were in this category with a 90% survival at 6 months.

Adult↗
PubMed1995

Advances in kidney transplantation: 1985-1995.

Graphs and tables published 10 years ago in our Clinical Kidney Transplants 1985 book are compared to current analyses. Impressive progress is apparent over the past decade. During this period, the effects of factors such as transfusion and the duration of first grafts on second grafts have disappeared, while the effects of factors such as cold ischemia time, regrafts and original disease have diminished in magnitude. Other factors, including HLA matching, donor age and race, continue to exhibit significant influence. It should be emphasized that most of these comparisons apply to one-year graft survival. Thus, our attention must now turn to factors which influence 10-year graft survival. Though 10 years is considered long-term survival to transplant physicians, for patients, it is but a brief period of life.

Adolescent↗
PubMed1994

Equitable allocation of HLA-compatible kidneys for local pools and for minorities.

BACKGROUND: The methods used to allocate cadaveric kidneys in the United States have been criticized as being unfair to minorities because of an over-emphasis on HLA matching. We evaluated a new HLA-matching method that might alleviate this problem. METHODS: We used data from the United Network for Organ Sharing (UNOS) Kidney Transplant Registry to evaluate and project the outcome of cadaveric kidney transplantation. An HLA-matching method based on compatibility at 10 key amino acid residues of HLA-A and B molecules and a limited number of HLA-DR types was evaluated with use of the HLA types of the patients currently on the national waiting list and waiting lists in Los Angeles and Birmingham, Alabama. RESULTS: With national kidney sharing, the projected 10-year rate of graft survival for transplants in which there were no HLA-A, B, or DR mismatches was 66 percent, as compared with 39 percent for transplants with more than two HLA-A, B, or DR mismatches. With local sharing, 43 percent of patients could be fully matched, and they had a projected 10-year graft-survival rate of 50 percent. When one HLA-DR mismatch was allowed, the projected 10-year graft survival was 46 percent, and 67 percent of patients waiting locally could receive such grafts. Even in Alabama, where 68 percent of the patients on the waiting list are black, 48 percent of waiting patients could obtain a matched kidney. CONCLUSIONS: Inserting two new HLA-matching categories into the UNOS point system for cadaveric kidney allocation would increase the number of patients for whom matches could be found in local pools.

Black People↗
PubMed1994

The hyperfiltration hypothesis in human renal transplantation.

The hyperfiltration hypothesis postulates that kidneys with reduced renal mass will progress toward failure due to hypertrophy of the remaining nephron to meet the excess load, eventually leading to nephron exhaustion. Five conditions in which hyperfiltration might be suspected were studied in human kidney transplantation: (1) small kidneys from donors aged 4 to 6; (2) transplants into large recipients (over 100 kg); (3) grafts from females to males compared with males to females; (4) kidneys that experience rejection episodes; and (5) cadaveric grafts compared with living-unrelated donor grafts. In all 5 instances, the requirement for dialysis and discharge serum creatinine level were both high--and, correspondingly, the 1- and 3-year graft survival rates were lower than the controls. The discharge SCr was the best indicator of 1-3-year graft survival and may serve to measure the "fit" of the kidney to the recipient--for even in patients requiring no dialysis graft survival was related to the discharge SCr levels. One consequence of this hypothesis is that many late graft losses currently attributed to rejections may, in fact, be hyperfiltration failures. As evidence, a progressively higher incidence of reported late rejections was noted even in patients who had been rejection-free at the time of discharge if they had higher discharge SCr values. We conclude that the 5 conditions under which hyperfiltration damage might be suspected had increased failure rates. Such failures are almost never reported as "due to hyperfiltration" and are probably recorded as rejections.

Female↗
PubMed1994

Kidney transplants in black recipients. HLA matching and other factors affecting long-term graft survival.

Primary kidney transplants from living related and cadaveric donors to black recipients failed twice as rapidly as those to white recipients in data reported to the United Network for Organ Sharing Scientific Renal Transplant Registry between 1987 and 1991. The projected half-life for 132 HLA-identical sibling donor transplants in blacks was 15 years versus 29 years for 1,033 whites (P < 0.001). For recipients of cadaveric grafts, the half-lives were 5 years for blacks (n = 5,282) and 10 years for whites (n = 14,917). The 1-year graft survival rates and half-lives improved with HLA matching in both blacks and whites, but the 2-fold difference in long-term survival rates persisted even among recipients of well-matched grafts. With a zero HLA-A,B-mismatched donor, blacks had an 8-year half-life, compared with 17 years for whites (P < 0.001). The racial difference was most marked in young adults, with a 15-20% disparity at 3 years between blacks and whites aged 16-30. Pediatric and older black patients had 3-year graft survival rates similar to those of whites. Antilymphocyte globulin or OKT3 prophylaxis improved graft survival by 2% at 1 year and 5% at 2 years among blacks, but the half-life remained 5.6 years. In contrast to these findings in the United States, 63 blacks transplanted in Canada had the same short- and long-term graft survival as whites, suggesting an important long-term influence of the health care system and socioeconomic factors. In addition to improved access to health care and improved HLA typing of blacks, more black donors are needed to provide better matched transplants for blacks awaiting transplants.

Adolescent↗
PubMed1994

Repeating HLA antigen mismatches in renal retransplants--a second class mistake?

Should HLA antigens that were mismatched in a renal transplant that failed be avoided in subsequent transplants? There were 890 retransplantations reported to the UCLA International Kidney Transplant Registry between 1985 and 1993 that had been performed in the face of a repeat HLA incompatibility. The 1- and 3-year regraft survival rates were 67% and 55%, respectively, for these retransplants, compared with 73% and 60% for 3220 regrafts with no HLA-A, -B, or -DR antigens mismatched twice (P = 0.030). When the repeat HLA-mismatched antigens were examined by locus, there was no difference in regraft survival comparing patients with no repeat HLA incompatibilities with those mismatched twice for HLA-A or -B antigens only, but there was a significant long-term decrease in survival of patients mismatched twice for HLA-DR antigens. The 377 patients mismatched twice only for HLA-A or -B antigens had 1- and 3-year regraft survival rates of 67% and 59%, respectively, compared with 65% (P = 0.289) and 50% (P = 0.025) for 281 patients with HLA-DR repeat mismatches only. Repeat mismatches for a combination of HLA-A or -B and -DR antigens resulted in 65% and 44% 1- and 3-year regraft survival in 129 patients. The half-lives for retransplants with repeat HLA class I, II, and I and II incompatibilities were 8, 6, and 4 years, respectively (P = 0.005). The data do not support preemptive avoidance of repeat HLA-A or -B incompatibilities. The crossmatch test excludes relevant mismatches. Repeated HLA-DR incompatibilities are not excluded by crossmatch tests and have a deleterious effect on long-term regraft survival. HLA-DR antigens mismatched in a previous failed transplant should be avoided.

Graft Survival↗
PubMed1994

HLA matching for improved cadaver kidney allocation.

Because long-term results of kidney transplantation are still unsatisfactory, efforts are needed to improve them, particularly through the allocation of well-matched kidneys to recipients. In the past 7 years, the United Network of Organ Sharing 6-antigen match program has established that superior results can be obtained with the national sharing of available no HLA-A, -B, or -DR antigen mismatched kidneys. In addition to strengthening this program, the 1 HLA-A, -B, or -DR antigen-permissible mismatched kidneys should also be shared nationally. Approximately half of the recipients would receive nationally matched kidneys and the remaining recipients would be allotted kidneys locally, with distribution based on fewer risk factors (eg, residues) and on waiting points. This residue matching method was shown to result in more equitable kidney distribution to minorities.

Cadaver↗
PubMed1994

The UNOS Scientific Renal Transplant Registry. United Network for Organ Sharing.

1. The number of cadaveric transplants performed each year at United States transplant centers has increased very little, from 7,200 in 1988 to 8,100 in 1993. Living-donor transplants increased during the same period from 1,656 to 2,562. 2. The recipient and donor populations have aged since UNOS began collecting data. In 1988, 39% of first-cadaver transplant recipients were over age 45 compared with 45% in 1993. During the same period, the percentage of cadaver kidneys from donors over age 45 increased from 16% to 26%. 3. Recipients over age 60 or under age 19 had 65% 3-year graft survival rates compared with 70% for those in the intervening age groups (p < 0.001). As many as 60% of graft failures after the first year were accounted for by deaths with a functioning graft when the recipient was over 60 compared with less than 15% when the patient was under age 30 (p < 0.01). Rejection caused 45% of graft failures after the first year for recipients under age 45 but only 17% in those over 60 (p < 0.01). When deaths were censored in the graft survival calculation, recipients over age 45 had the highest 3-year survival rate of 79% compared with 72% for those aged 6-18 (p < 0.001). 4. The 3-year graft survival rate for kidneys from donors over age 60 was 55% and from donors aged 46-60 or under 5, it was 58%. Both results were significantly poorer than the 75% survival rate achieved using kidneys from 19 to 30 year-olds. 5. The racial distribution among first-cadaver kidney transplants has been relatively stable between 1988 and 1993, with 60% Whites, 23% Blacks, 8% Hispanics, 3% Asians, and the remainder, other groups. One-year graft survival rates were consistently 3-5% lower for Blacks than for other races (p < 0.001), and the difference increased to 12% by 3 years. The poorer survival rates for Blacks were unaffected by the donor's race. Blacks had the highest patient survival rates. More than 38% of first year failures and 47% of later failures in Blacks were due to rejection, compared with 31% for Whites in both periods (p < 0.01). When deaths were censored from the survival calculation, the graft half-life increased from 11 to 15 years for Whites but only from 5 to 6 years for Blacks. 6. Diabetes became the most prevalent disease among first-cadaver transplant recipients, accounting for 28% of the 1993 activity.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

UCLA liver transplantation: analysis of the first 1,000 patients.

Graft and patient survival rates for Black patients were higher than for any group. This may be due to the younger age distribution among Black transplant recipients versus other races at UCLA. Graft and patient survival for Asian patients were significantly lower than for any other group. However, this result was not totally accounted for by the rapid recurrence of disease in hepatitis B patients. Patients with a positive flow cytometry crossmatch had significantly lower first and second graft survival rates due to early graft loss. Patients with PRA of more than 10% had a higher proportion of positive flow crossmatches. However, as a group, patients with more than 10% PRA did not demonstrate decreased graft survival. Consideration should be given to prospectively flow crossmatching the more than 10% PRA group. Patients with zero-DR mismatches had better survival than patients with one- and 2-DR mismatches. Prospective HLA matching in OLT patients is not currently done.

Adolescent↗
PubMed1994

Donor factors.

1. Although left kidneys had a 2% higher graft survival rate at one-year posttransplant, the survival rates for left and right kidneys were comparable at 2, 3, and 4 years after transplantation. Kidneys transplanted en bloc were shown to have a 6% lower graft survival rate than either left or right kidneys. 2. Male donor kidney had a 4% higher rate of graft survival than female donor kidneys at both one and 4 years posttransplant. 3. Kidneys obtained from Black donors had a 4% lower graft survival rate at one-year posttransplant, and a 7% lower graft survival rate at 4 years after transplantation than White donor kidneys. White, Hispanic, and Asian donors all had comparable rates of graft survival at one, 2, and 3 years posttransplant. Black donor kidneys also had a significantly shorter half-life; 6.7 years, compared with 7.1 years for kidneys from Asian donors, 9.7 years for Hispanic donors, and 8.6 years for White donors. Blacks continued to make up a small fragment of the total donor pool, accounting for less than 10% of all cadaveric donor kidneys. 4. Kidneys from type O donors had a 5% higher graft survival rate at 4 years posttransplant when compared to AB kidneys and had a 2% higher 4-year graft survival rate than either type A or B kidneys. 5. Pediatric (younger than 5 years of age) donor kidneys had a 10% lower graft survival rate than kidneys from donors between 6 and 45 years of age. Kidneys from donors over 60 years of age had an 11% lower one-year graft survival rate than donors between 6 and 45 years of age, and a 19% lower survival rate at 4 years posttransplant. Survival rates decreased with increasing donor age; kidneys from donors between 46 and 60 years of age had a 5% lower graft survival rate at one year, and a 9% lower rate of graft survival at 4 years posttransplant when compared to "middle aged" donors. The poorest graft survival was observed for kidneys from donors over 60 years of age; 10% and 19% lower graft survival at one and 4 years posttransplant, respectively, compared to donors between 6 and 45 years of age. 6. Kidneys from trauma donors had a 4% higher survival rate at one-year posttransplant, and a 6% higher survival rate at 4 years posttransplant when compared to kidneys from nontrauma donors. Kidneys obtained from victims of motor vehicle accidents, traumatic suicides, and assaults (gunshot wounds and stabbings) had the highest rate of graft survival.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Primary disease effects and associations.

1. Although graft survival for most primary disease processes are similar at one year, significant divergence occurs by 5 years. ALP, IGA, and PC had the highest 5-year graft survival rates (72.8%, 71.2%, and 68.5%, respectively) whereas HTN and NS, the lowest (51.8% and 46.0%, respectively). 2. When primary diseases are grouped by pathogenic, pathophysiologic, and clinical similarities, the group of diseases with systemic manifestations had the lowest 5-year graft survival (55%), and the group including cystic and inherited diseases had the highest 5-year graft survival (69%). Black recipients had a predominance of "systemic" primary diseases (57%). 3. Despite having overall lower graft survival than Whites (p < 0.00001), there was no significant difference between Black and White 3-year graft survival for recipients with PC, ALP, IGA, and SLE. 4. PC recipients enjoyed excellent long-term graft survival (69%). Black recipients with PC had a 5-year graft survival rate of 64.6%. Recipients with PC had decreased posttransplant dialysis need, decreased early rejection rate, and better HLA matching than most other recipients. 5. Recipients with SLE as their primary disease had among the highest fraction of grafts lost to rejection (45.4% of all grafts lost) and the highest pretransplant sensitization rate (59.6%). 6. Recipients with HTN as their primary disease had overall lower 5-year graft survival (58% versus 63% in Whites, 44% versus 47% in Blacks), a lower rate of early allograft function (10% versus 12%, p < 0.00001), and more posttransplant dialysis needs (28.8% of patients requiring dialysis vs 23.5%, p < 0.00001) than recipients without HTN. Blacks with HTN had the lowest long-term graft survival (44.4%) of any other single group. 7. IDDM patients who expressed DR3 and/or DR4 alleles had significantly higher graft survival than patients without these DR groups. Whites expressing DR3 and DR4 and DR3 or DR4 alleles had better overall HLA matching (p < 0.001) and graft survival (75.4% and 70.7% versus 58.5% and 65.1%, p < 0.00001) than Blacks with similar DR expression. 8. SPK recipients had better 5-year graft survival than KAT recipients (66.2% versus 54.6%, p < 0.000001). This effect is most likely due to the selection of "better" lower-risk patients for SPK grafts.

Adolescent↗
PubMed1994

HLA matching effect: better survival rates and graft quality.

1. HLA matching remains a major factor in kidney transplantation. Much of the total graft failures can be eliminated through better HLA matching. 2. Very early effects of HLA matching can be seen with the requirement of dialysis within one week. 3. Even among kidneys which are functioning at the beginning of each period, more frequent rejection treatment with increasing numbers of A,B,DR mismatches was observed. 4. Among functioning kidneys, HLA matching affects the quality of kidney function, as reflected in the serum creatinine levels during all periods. 5. Immunological graft failures (regardless of cause) are strongly associated with HLA mismatching. 6. The effect of HLA matching was similar at centers with high or low overall graft survival rates. 7. The fraction of zero-A,B,DR mismatches has increased dramatically in recent years. However, this is a large difference in the numbers between centers and OPOs. 8. Preformed cytotoxic antibodies to HLA tend to force a higher degree of matching for the A and B loci, resulting from T-lymphocyte crossmatching. 9. Because of the linkage of the 3 HLA loci (A, B, and DR), matching for one often results in matching for 2 or 3 of the loci. 10. Chronic glomerulonephritis patients having DR1 had superior graft survival rates than patients without DR1. 11. HLA frequencies in IDDM, hypertensive nephropathy, CGN and PC were significantly different from controls in many Class II specificities and some Class I specificities.

Disease Susceptibility↗
PubMed1994

Cytomegalovirus antibody status and kidney transplantation.

1. First cadaver-donor recipients had a 7% death rate if the kidney originated from a CMV+ donor compared with 5% if the kidney came from a CMV-donor. This 2% difference was highly significant (p < 0.001). Graft survival rates were correspondingly 2-3% lower as a result of deaths. 2. This same trend was noted in the 1991-1993 period as in the 1988-1990 period. 3. Increased incidence of deaths in D+/R+ transplants was most frequently statistically significant when patients were divided by early function. 4. Death rates in diabetics rose from 7% in D-/R- combinations to 13% in D+/R- patients (p < 0.001). Patients with other diseases did not show as marked an effect. 5. Among kidneys from living-related donors, there was no noticeable effect of donor CMV status. Thus, for these donors, no precautions need be taken regarding CMV status. Spousal-donor transplants had a higher graft survival if a D-/R- rather than other combinations were used. 6. The incidence of CMV positivity was slightly higher in Black patients compared with Caucasians, in females compared with males, and increased progressively with age. CMV positivity increased in patients with multiple grafts, presumably because transplanted patients increased in CMV positivity. Among patients who were on dialysis, the CMV positivity was higher than in donors of cadaver organs. There was a substantial difference in CMV positivity in different areas of the country, ranging from 36% in Ohio to 65% in Washington. 7. The HLA matching effect was greater than the CMV effect, justifying its use as the main prospective factor in kidney allocation. CMV prophylaxis is needed for patients receiving kidneys from CMV+ donors. The data indicate that, whenever possible, CMV+ donor kidneys should not be used for CMV- IDDM patients.

Adolescent↗
PubMed1994

Outcome statistics of renal transplants with an emphasis on long-term survival.

Remarkable increases in cadaveric renal transplant survival rates have been seen following improvements in areas such as immunosuppression, organ preservation, HLA typing and cross-matching, and blood transfusion protocols. However, while these improvements have influenced survival in the early post-transplant period up to 6 months, the cumulative rate of graft loss beyond the 1st year has remained constant at about 9% a year over the past 25 years. Several factors that affect long-term survival have been identified through univariate and multivariate analyses. Chief among these is the detrimental effect of HLA-A and HLA-B antigen mismatching. Also important are the recipient's race, sex, and age, and presence of diabetes, as well as the donor's age, sex, and cause of death, and long cold ischemia times. Likewise, post-transplant events, including delayed graft function, early rejection episodes, and discharge serum creatinine levels strongly affect long-term graft survival. Chronic rejection should also be recognized as a major contributor to the long-term failure rate, but there is currently no reliable way to identify or classify it in the UNOS Scientific Renal Transplant Registry database. Characteristics that define chronic rejection must be identified to allow transplant centers to accurately report its incidence and to enable investigators to analyze and monitor its impact on transplant outcome.

Adult↗