When should the third renal transplant rejection episode be treated?

Area of Science:

• Nephrology
• Transplantation Immunology
• Clinical Medicine

Background:

• Repeated renal allograft rejection episodes impact long-term graft survival.
• Current criteria for graft removal after rejection are undefined.
• Patient survival may be better when repeatedly rejected allografts are removed.

Purpose of the Study:

• To analyze the relationship between the number of rejection episodes and renal allograft survival.
• To develop a predictive formula for one-year graft survival after the third rejection episode.
• To assess the impact of rejection episodes on patient survival.

Main Methods:

• Retrospective analysis of 316 patients with first renal allografts (1968-1973).
• Development of a predictive formula based on baseline renal function and rejection severity.
• Validation of the formula on a separate cohort of 19 patients (1974).

Main Results:

• Graft survival was inversely related to the number of rejection episodes (100% for none vs. 21% for three).
• A predictive formula for one-year survival after the third rejection was 87% accurate in the derivation group and 68% in the validation group.
• Patient survival was significantly lower in patients with one or more rejection episodes (65%) compared to those with none (89%).

Conclusions:

• Graft survival significantly decreases with an increasing number of rejection episodes.
• The developed formula shows potential for predicting one-year renal allograft survival after three rejection episodes.
• Patient survival is significantly impacted by even a single rejection episode, with increased risk of bacterial infection after multiple rejections.