CLINICAL PROFILE AND COURSE AND OUTCOME OF LATE ACUTE REJECTION EPISODES IN LIVING-RELATED-DONOR RENAL-ALLOGRAFT RECIPIENTS

We prospectively monitored clinical data and renal function at monthly intervals in 165 patients who had received living-related-donor renal allografts in our institution between January 1981 and December 1991 and had a functioning allograft for I year or longer, During a mean fo llow-up period of 47.2 (range 13-155)months, 32 patients(l7.2%) develo ped late acute rejections, of which 14 (43.7%) were asymptomatic. Amon gst the symptomatic late acute rejections, worsening of hypertension w as the commonest finding, being present in I I (61.1%)patients, follow ed by oliguria in 8 (44.4%) and weight gain in 7 (38.8%) patients. Of these 32 late acute rejections, as many as 28 (87.5%) showed a respons e to antirejection therapy with high-dose steroids: 5 (15.6%) a comple te response and 23 (71,9%) a partial response. The response rate was 1 00% if it was the first acute rejection (20% complete and 80% partial) , 78.6% if it was the second (14.3% complete and 64.3% partial), and n o or only a partial response to treatment if it was the third acute re jection episode. On long-term follow-up, patients who had responded to antirejection treatment had a significantly better graft survival as compared with nonresponding patients: 76 and 27%, respectively. Our ob servations suggest that routine monitoring of the renal function at fr equent intervals is essential for early diagnosis and treatment of acu te rejections, even during the late posttransplant period. The chances of a response to antirejection therapy are higher during the first ep isode of late acute transplant rejection as compared with a second or a third late rejection event.