[Early rejection crises and prognosis of the renal graft]

The present study including 136 cadaver kidney transplants in 119 recipients has shown that the long term function and survival of kidney grafts are closely related to the early immunological reactions of the recipients. Under conventional immunosuppression the most important period for the outcome of the grafts extends to the first 4 months. Not only the number but especially the severity of the early rejection episodes are of prognostic value. Two groups can be distinguished using a classification of severity of early rejection episodes: the first one is characterized by an excellent graft survival and late function (87% one year graft survival) and includes those kidneys with zero or only 1-2 slight early rejection crisis (type 1 and/or 2). In the second group with more than two slight crisis or more severe forms of rejections (type 3 or 4) the one year graft survival is significantly reduced (52%: p less than 0.01). In this group compensatory hypertrophy is usually absent. This is in opposition to the functional improvement of 14 ml/min of GFR after 12 months observed in the patients with good immunological tolerance.