The influence of acute rejection on long-term renal allograft survival: A comparison of living and cadaveric donor transplantation

Background. We investigated whether recipients of living donor grafts who s uffer an acute rejection progress to graft loss because of chronic rejectio n at a slower rate than recipients of cadaveric grafts. Methods. A retrospective review was made of 296 renal transplantations perf ormed at Mount Sinai Hospital. Only grafts functioning for at least 3 month s were included in this analysis. Demographic variables of donor and recipi ent age, race, sex, and serum creatinine at 3 months after transplantation were compared between groups. Results. Among the acute rejection-free cohort, the estimated 5-year graft survival was 90% far those receiving transplants from living relatives and 88% for those receiving cadaveric transplants (P=0.76). However, in grafts with early acute rejection, the 5-year survival was 40% for cadaveric recip ients compared with 73% for living related graft recipients (P<0.014), Usin g the proportional hazards model, cadaveric donor source, older donor age, African American recipient race, and elevated 3-month serum creatinine were independent predictors of long-term graft loss caused by chronic rejection . The severity of acute rejection and recipient age had no impact on the ri sk of graft loss because of chronic rejection. Conclusion. These data indicate that the benefit of living related transpla ntation results from the fact that a living related graft progresses from a cute to chronic rejection at a slower rate than a cadaveric graft. Furtherm ore, a cadaveric graft that is free of acute rejection 3 months after trans plantation has an equal likelihood of functioning at 5 years as that of a g raft from a living related donor.