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PubMed2000

Impact of delayed graft function and acute rejection on kidney graft survival.

1. From 1991 to 1998, the incidence of DGF remained at 21% of all kidney grafts (n = 86,682) reported to the UNOS Scientific Transplant Registry. In contrast, percentages of early acute rejection (EAR) and late acute rejection (LAR) have dropped precipitously to half their starting values. (EAR started at 37% and dropped to 18%, and LAR started at 11% and dropped to 5%.) 2. Among discharged recipients, DGF was associated with increased EAR (odds ratio = 1.7) within 6 months of transplant; whereas, EAR (odds ratio = 4.7) but not DGF (odds ratio = 1.1) was associated with increased LAR for recipients from 6 months to one year after transplantation. 3. Non-immune factors (e.g., duration of pretransplant dialysis, donor age, and cold ischemia time) primarily influenced the risk of DGF, and immune factors (e.g., recipient race, recipient age, HLA) mainly determined the risk of EAR and LAR. 4. DGF, EAR and LAR were independent risk factors for long-term graft loss. DGF and LAR exhibited the strongest influences, reducing half-lives by 30% and 50%, respectively. 5. Some long-term risk factors demonstrated consistent effects regardless of DGF and/or LAR. For example, Black recipients always had poor long-term GS. On the other hand, some risk factors, mostly immune-type factors, exhibited effects only in the absence of DGF (e.g., recipient sex, age and HLA matching). Many non-immune factors exhibited long-term effects only in the absence of LAR (e.g., donor age, cause of donor death). 6. Strategies aimed at reducing both DGF and AR are necessary to improve the long-term outcome of kidney transplants.

Acute Disease↗
PubMed1989

OKT3 prophylaxis in cadaveric kidney transplant recipients with delayed graft function.

Decreased 1-year allograft survival rates have frequently been observed in cadaveric renal allograft recipients with postoperative acute tubular necrosis (ATN), even in the cyclosporine era. Use of cyclosporine despite ATN may lead to a prolongation of ATN, while withholding cyclosporine may increase the chance of an early rejection episode. Prophylactic polyclonal antilymphocyte antibodies have been used postoperatively to prevent rejection while avoiding cyclosporine nephrotoxicity. Since January 1987, the authors have used OKT3 monoclonal antibody prophylaxis in all cadaver kidney recipients with ATN (n = 26). The posttransplant course of these patients was compared with that of cadaveric kidney recipients with ATN who received transplants in 1985-1986 and were treated with cyclosporine during ATN (n = 40). Allograft survival rates in these patients were also compared with those observed in cadaver kidney recipients with immediate graft function. The 1-year graft survival rate was significantly better in the ATN patients who received OKT3 prophylaxis (83%) than in those who were treated early with cyclosporine during the period of ATN (55%). The mean duration of OKT3 therapy was 11.1 +/- 2.5 days. There was no significant difference in 1-year graft survival rates between the ATN patients treated with OKT3 prophylaxis and patients who had immediate graft function (74%, 1985 through 1988 combined). Patient survival was unaffected by the occurrence of ATN or the postoperative immunosuppressive protocol. The duration of ATN was shortened (9.3 +/- 4.0 v 14.9 +/- 10.2 days), and the median time to first rejection was prolonged (23.5 v 11.0 days) by OKT3 prophylaxis compared with early cyclosporine.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗