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Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most
Herwig-Ulf Meier-Kriesche1, Jesse D Schold, Titte R Srinivas
1University of Florida, College of Medicine, Division of Nephrology, Gainesville, FL, USA. Meierhu@medicine.ufl.edu
Summary
Decreasing acute rejection rates in kidney transplants did not improve graft survival. In fact, recent trends show worse death-censored graft survival, warranting further investigation into the causes.
Area of Science:
- Nephrology
- Transplant Surgery
- Immunology
Background:
- Acute rejection significantly impacts kidney graft survival.
- Current immunosuppressive protocols aim for low acute rejection rates.
- Understanding recent trends in acute rejection and graft survival is crucial.
Purpose of the Study:
- To investigate the evolution of acute rejection rates nationally in the U.S.
- To determine the impact of these rates on graft survival in recent kidney transplantation eras.
- To analyze trends between 1995 and 2000.
Main Methods:
- Analysis of adult first renal transplant data from the Scientific Registry of Transplant Recipients (SRTR).
- Inclusion period: 1995-2000.
- Evaluation of acute rejection rates and graft survival outcomes.
Main Results:
- A significant decrease in acute rejection rates was observed within the first year and into the second year post-transplant.
- No significant improvement in overall graft survival was noted.
- A statistically significant trend towards worse death-censored graft survival was identified.
- An increasing proportion of rejection episodes failed to achieve full functional recovery post-treatment.
Conclusions:
- Decreasing acute rejection rates between 1995 and 2000 did not enhance long-term kidney graft survival.
- A higher proportion of unresolved acute rejections may contribute to poorer outcomes.
- The reasons for worse death-censored graft survival trends require further investigation.