LONG-TERM GRAFT OUTCOME IS NOT NECESSARILY AFFECTED BY DELAYED-ONSET OF GRAFT FUNCTION AND EARLY ACUTE REJECTION

Background. Both acute rejection episodes and delayed graft function ( DGF) have been shown to be associated with decreased 1-year renal allo graft survival, In our center, the incidence and the intensity of acut e rejection episodes have been reduced by cyclosporine-based triple-dr ug therapy, We have also shown that DGF alone is not a risk factor for long-term graft survival, Methods, We have now investigated whether a n acute rejection episode together with DGF significantly effects long -term graft outcome, This study involved 862 first cadaveric renal all ografts and 182 regrafts. Results, The incidence of DGF was 33% after first transplants and 44% after retransplants. The overall incidence o f acute rejection episodes was 23% in first grafts and 28% in regrafts ., After first grafts, there were no statistically significant differe nces in graft survival rates and half-lives between the early graft fu nction (EGF) and DGF groups with or without acute rejection, In regraf ts, graft survival was significantly higher in the EGF group without a cute rejection than in the DGF group with acute rejection, However, if all other causes except chronic rejection were censored, the half-lif e in the EGF group without acute rejection was 17.3 years in first gra fts, and in the DGF group with acute rejection, that number was 11.5 y ears in first grafts; for regrafts, the half-life was 12.3 years and 6 .1 years, respectively, Conclusions, Acute rejection together with DGF could contribute to initial damage to the graft, and this might lead to later chronic allograft failure, In our study, this effect was evid ent only in the case of retransplants.