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Cell‐mediated and humoral acute vascular rejection and graft loss: A registry study
Author(s) -
Teo Rachel ZC,
Wong Germaine,
Russ Graeme R,
Lim Wai H
Publication year - 2016
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12577
Subject(s) - medicine , hazard ratio , dialysis , confidence interval , proportional hazards model , kidney transplantation , transplantation , gastroenterology , surgery
Aims Rejection of renal allografts following transplantation continues to be a major impediment to long‐term graft survival. Although acute vascular rejection ( AVR ) is associated with a high risk of graft loss, it remains unclear whether AVR with accompanied cellular or acute humoral rejection ( AHR ) have dissimilar outcomes. The aim of this registry study was to examine the association between subtypes of AVR and graft loss. Methods Using A ustralia and N ew Z ealand Dialysis and Transplant registry, primary kidney transplant recipients between 2005 and 2012 whose first rejection episode was AVR were included and categorized into AVR ‐none ( AVR without other rejections), AVR‐CG ( AVR with cellular and/or glomerular rejections), and AVR‐AHR ( AVR with AHR ). Association between AVR groups and graft loss was examined using logistic and C ox regression models. Results Of the 274 recipients, 61 (22.3%) experienced AVR ‐none, 79 (28.8%) AVR‐AHR and 134 (48.9%) AVR‐CG . Compared with AVR ‐none and AVR‐CG , AVR‐AHR was associated with the highest incidence of overall graft loss at 3 months (12%, 10% and 27%, respectively, χ 2 = 11.88, P = 0.003). AVR‐AHR was associated with almost a threefold greater risk of death‐censored graft loss compared with AVR ‐none (adjusted hazard ratio 2.84, 95% confidence interval 1.22–2.62, P < 0.01). Conclusion AVR‐AHR is associated with the poorest outcome with over 25% of grafts being lost 3 months after transplantation. Future studies evaluating factors that predict graft loss in AVR‐AHR may help determine prognosis and inform treatment practices.