Acute rejection following renal transplantation. Evidence that severity isthe best predictor of subsequent graft survival time

Timely recognition of risk factors influencing graft survival time followin g kidney transplantation could facilitate the development of clinical inter ventions that would increase the longevity of graft survival. To identify t hese risk factors, we performed a retrospective analysis of the clinical ou tcome of 1949 renal transplants pet-formed at The Ohio State University Tra nsplant Program between 22 September 1982 and 14 June 1996. The number of a cute rejection (AR) episodes was most predictive of shorter graft survival time. The first AR episode severity (indexed using the difference between p ost-treatment serum creatinine (RxCr) and baseline serum creatinine (BCr), or DeltaCr = RxCr - BCr) was the best predictor of graft survival time (r = 0.27, p < 0.0001) in patients experiencing AR. Subsequent AR episodes occu rred more frequently in patients with a higher DeltaCr. However, DeltaCr wa s the best predictor of graft survival time (r = 0.44, p < 0.0001) in patie nts who had only one AR episode. The severity of the first AR episode (Delt aCr) correlated with the risk of subsequent AR episodes, the severity of a second AR episode and the average of mean blood pressures obtained after, b ut not before, the first AR episode. Therefore, we conclude that the severi ty of the first AR episode was the best predictor of renal allograft surviv al time in all patients experiencing AR, independent of subsequent AR episo des and con-elated with subsequent clinical events which also influence ren al allograft survival time. Thus, early diagnosis and aggressive treatment of the first AR episode are warranted to minimize AR severity and thereby m aximize subsequent graft survival time. Conclusions. The severity of the first acute rejection episode following re nal transplantation is the best determinant of graft survival time and corr elates with subsequent clinical events which could further reduce graft sur vival time.