Decreased acute rejection in kidney transplant recipients is associated with decreased chronic rejection

Objective To determine whether a recent decrease in the rate of acute rejec tion after kidney transplantation was associated with a decrease in the rat e of chronic rejection. Summary Background Data Single-institution and multicenter retrospective an alyses have identified acute rejection episodes as the major risk factor fo r chronic rejection after kidney transplantation. However, to date, no stud y has shown that a decrease in the rate of acute rejection leads to a decre ase in the rate of chronic rejection. Methods The authors studied patient populations who underwent transplants a t a single center during two eras (1984-1987 and 1991-1994) to determine th e rate of biopsy-proven acute rejection, the rate of biopsy-proven chronic rejection, and the graft half-life. Results Recipients who underwent transplantation in era 2 had a decreased r ate of biopsy-proven acute rejection compared with era 1 (p < 0.05). This d ecrease was associated with a decreased rate of biopsy-proven chronic rejec tion for both cadaver (p = 0.0001) and living donor (p = 0.08) recipients. A trend was observed toward increased graft half-life in era 2 (p = NS). Conclusions Development of immunosuppressive protocols that decrease the ra te of acute rejection should lower the rate of chronic rejection and improv e long-term graft survival.