RISK-FACTORS PREDICTING CHRONIC REJECTION OF RENAL-ALLOGRAFTS

Chronic rejection is clinically defined as a gradual but progressive i mpairment of renal allograft function in the absence of other specific causes. The risk factors predisposing to chronic rejection are incomp letely known. In this prospective single-center project, logistic regr ession analysis was used to study the long-term outcome of 94 consecut ive first renal allografts in relation to 10 potential risk factors. W hether serum lipid levels, histopathological changes or the mode of im munosuppressive therapy had a predictive value for chronic rejection w as of special interest. The risk factors for renal allograft outcome w ere determined 2 years after the transplantation, when graft function was still normal, and the results were evaluated 2 years later. Occurr ence of acute rejections, cold ischemia time, the high-density lipopro tein cholesterol level, and the high-density lipoprotein and total cho lesterol ratio were not significant predictors of graft outcome. In a univariate analysis, triglyceride, total cholesterol, and low-density lipoprotein cholesterol level, and donor age were significantly relate d to graft outcome. In a logistic regression analysis, triple immunosu ppressive therapy was better than any double-drug regimen in preventin g the deterioration of renal allografts. Incipient histological change s in graft biopsy, quantitated as the ''chronic allograft damage index ,'' was the most important single predictor of chronic rejection. The effect of both the histological changes and low-density lipoprotein ch olesterol on adverse graft outcome was level dependent.