CLINICAL CORRELATES OF CHRONIC REJECTION IN PEDIATRIC RENAL-TRANSPLANTATION - A REPORT OF THE NORTH-AMERICAN PEDIATRIC RENAL-TRANSPLANT COOPERATIVE STUDY

A total of 1699 patients with living donor transplants and 1795 patien ts with cadaver donor transplants entered between January 1987 and Nov ember 1994 in the North American Pediatric Renal Transplant Cooperativ e Study registry form the cohort for this report. Failure from chronic rejection occurred in 76 (4.5%) of living donor transplants and 149 ( 8.3%) of cadaver transplants. Chronic rejection is the leading cause o f graft failure, with 27% of living donor and 26.7% of cadaver donor g raft failures attributed to chronic rejection. Univariate and multivar iate analyses of various risk factors revealed acute rejection (relati ve risk [RR] = 3.1, P<0.001) and greater than two acute rejections (RR = 4.3, P<0.001) to be the most common correlates of chronic rejection . Additionally, late initial acute rejection (>365 days; RR = 2.3, P<0 .001) was also correlated. Cadaver donor source (RR = 1.6, P = 0.001) and African-American race (RR = 1.6, P<0.003) were weaker but signific ant risk factors. An analysis of cyclosporine dosing revealed that a d ose of <5 mg/kg/day at day 30 was also a risk factor (RR = 1.5, P = 0. 027). Our study concludes that acute rejection is the single most crit ical element in the genesis of chronic rejection. Thus, measures to pr event the first episode of acute rejection could ameliorate the incide nce of chronic rejection.