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Long-Term Outcomes after Acute Rejection in Kidney Transplant Recipients: An ANZDATA Analysis
Philip A Clayton1,2,3, Stephen P McDonald1,2,3, Graeme R Russ1,2,3
1Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
Journal of the American Society of Nephrology : JASN
|July 17, 2019
Summary
Acute rejection (AR) in kidney transplants increases long-term risks of graft failure, cardiovascular disease, and cancer death. Monitoring AR is crucial for patient outcomes and clinical trials.
Area of Science:
- Nephrology
- Transplant Immunology
- Clinical Outcomes Research
Background:
- Acute rejection (AR) rates and 1-year graft survival in kidney transplant recipients are being re-evaluated.
- The long-term impact of AR and its treatments on patient outcomes requires further investigation.
Purpose of the Study:
- To analyze the long-term effects of acute rejection on graft survival and mortality in kidney transplant recipients.
- To determine the association between early acute rejection and subsequent cause-specific graft loss and death.
Main Methods:
- Utilized data from 13,614 primary kidney-only transplant recipients (1997-2017) with at least 6 months graft function.
- Employed Cox models to assess associations between AR within 6 months post-transplant and long-term outcomes, adjusting for baseline characteristics.
Main Results:
- Acute rejection occurred in 21.4% of recipients and was linked to graft loss from chronic allograft nephropathy (HR 1.39) and recurrent AR (HR 1.85).
- Early AR also correlated with increased risk of death with a functioning graft (HR 1.22), cardiovascular disease death (HR 1.30), and cancer death (HR 1.35).
Conclusions:
- Acute rejection is associated with elevated risks of long-term graft failure and mortality, including from cardiovascular disease and cancer.
- Acute rejection remains a critical short-term outcome to monitor in kidney transplantation and associated clinical trials.
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