Increased impact of acute rejection on chronic allograft failure in recent era

H. U. Meier-Kriesche, A. O. Ojo, J. A. Hanson, D. M. Cibrik, J. D. Punch, A. B. Leichtman, Bruce Kaplan

Research output: Contribution to journalArticle

159 Citations (Scopus)

Abstract

Background. Acute rejection (AR) remains a major risk factor for the development of chronic renal allograft failure (CAF), which is a major cause of late graft loss. With the introduction of several newer immunosuppressive agents (e.g., mycophenolate mofetil, tacrolimus and neoral) acute rejection rates have been steadily decreasing. However, the incidence of CAF has not decreased as dramatically as the incidence of acute rejection. One possible explanation is that the impact of AR on CAF is changing. The goal of this study was to analyze the relative impact of AR era on the development of CAF. Methods. We evaluated 63,045 primary renal transplant recipients reported to the USRDS from 1988 to 1997. CAF was defined as graft loss after 6 months posttransplantation, censored for death, acute rejection, thrombosis, infection, surgical complications, or recurrent disease. A Cox proportional hazard model correcting for 15 possible confounding factors evaluated the relative impact of AR on CAF. The era effect (years 1988-1989, 1990-1991, 1992-1993, 1994-1995 and 1996-1997) was evaluated by an era versus AR interaction term. Results. An AR episode within the first 6 months after transplantation was the most important risk factor for subsequent CAF (RR=2.4, CI 2.3-2.5). Compared with the reference group (1988-89 with no rejection), having an AR episode in 1988-89, 1990-1991, 1992-1993, 1994-1995, and 1996-1997, conferred a 1.67, 2.35, 3.4, 4.98 and 5.2-fold relative risk for the subsequent development of CAF (P <0.001). Conclusions. Independently of known confounding variables, the impact of AR on CAF has significantly increased from 1988 to 1997. This effect may in part explain the relative lack of improvements in long term renal allograft survival, despite a decline in AR rates.

Original languageEnglish (US)
Pages (from-to)1098-1100
Number of pages3
JournalTransplantation
Volume70
Issue number7
StatePublished - Oct 15 2000
Externally publishedYes

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Allografts
Chronic Kidney Failure
Mycophenolic Acid
Transplants
Kidney
Confounding Factors (Epidemiology)
Incidence
Tacrolimus
Immunosuppressive Agents
Proportional Hazards Models
Cyclosporine
Thrombosis
Transplantation
Infection

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Meier-Kriesche, H. U., Ojo, A. O., Hanson, J. A., Cibrik, D. M., Punch, J. D., Leichtman, A. B., & Kaplan, B. (2000). Increased impact of acute rejection on chronic allograft failure in recent era. Transplantation, 70(7), 1098-1100.

Increased impact of acute rejection on chronic allograft failure in recent era. / Meier-Kriesche, H. U.; Ojo, A. O.; Hanson, J. A.; Cibrik, D. M.; Punch, J. D.; Leichtman, A. B.; Kaplan, Bruce.

In: Transplantation, Vol. 70, No. 7, 15.10.2000, p. 1098-1100.

Research output: Contribution to journalArticle

Meier-Kriesche, HU, Ojo, AO, Hanson, JA, Cibrik, DM, Punch, JD, Leichtman, AB & Kaplan, B 2000, 'Increased impact of acute rejection on chronic allograft failure in recent era', Transplantation, vol. 70, no. 7, pp. 1098-1100.
Meier-Kriesche HU, Ojo AO, Hanson JA, Cibrik DM, Punch JD, Leichtman AB et al. Increased impact of acute rejection on chronic allograft failure in recent era. Transplantation. 2000 Oct 15;70(7):1098-1100.
Meier-Kriesche, H. U. ; Ojo, A. O. ; Hanson, J. A. ; Cibrik, D. M. ; Punch, J. D. ; Leichtman, A. B. ; Kaplan, Bruce. / Increased impact of acute rejection on chronic allograft failure in recent era. In: Transplantation. 2000 ; Vol. 70, No. 7. pp. 1098-1100.
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abstract = "Background. Acute rejection (AR) remains a major risk factor for the development of chronic renal allograft failure (CAF), which is a major cause of late graft loss. With the introduction of several newer immunosuppressive agents (e.g., mycophenolate mofetil, tacrolimus and neoral) acute rejection rates have been steadily decreasing. However, the incidence of CAF has not decreased as dramatically as the incidence of acute rejection. One possible explanation is that the impact of AR on CAF is changing. The goal of this study was to analyze the relative impact of AR era on the development of CAF. Methods. We evaluated 63,045 primary renal transplant recipients reported to the USRDS from 1988 to 1997. CAF was defined as graft loss after 6 months posttransplantation, censored for death, acute rejection, thrombosis, infection, surgical complications, or recurrent disease. A Cox proportional hazard model correcting for 15 possible confounding factors evaluated the relative impact of AR on CAF. The era effect (years 1988-1989, 1990-1991, 1992-1993, 1994-1995 and 1996-1997) was evaluated by an era versus AR interaction term. Results. An AR episode within the first 6 months after transplantation was the most important risk factor for subsequent CAF (RR=2.4, CI 2.3-2.5). Compared with the reference group (1988-89 with no rejection), having an AR episode in 1988-89, 1990-1991, 1992-1993, 1994-1995, and 1996-1997, conferred a 1.67, 2.35, 3.4, 4.98 and 5.2-fold relative risk for the subsequent development of CAF (P <0.001). Conclusions. Independently of known confounding variables, the impact of AR on CAF has significantly increased from 1988 to 1997. This effect may in part explain the relative lack of improvements in long term renal allograft survival, despite a decline in AR rates.",
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AU - Meier-Kriesche, H. U.

AU - Ojo, A. O.

AU - Hanson, J. A.

AU - Cibrik, D. M.

AU - Punch, J. D.

AU - Leichtman, A. B.

AU - Kaplan, Bruce

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N2 - Background. Acute rejection (AR) remains a major risk factor for the development of chronic renal allograft failure (CAF), which is a major cause of late graft loss. With the introduction of several newer immunosuppressive agents (e.g., mycophenolate mofetil, tacrolimus and neoral) acute rejection rates have been steadily decreasing. However, the incidence of CAF has not decreased as dramatically as the incidence of acute rejection. One possible explanation is that the impact of AR on CAF is changing. The goal of this study was to analyze the relative impact of AR era on the development of CAF. Methods. We evaluated 63,045 primary renal transplant recipients reported to the USRDS from 1988 to 1997. CAF was defined as graft loss after 6 months posttransplantation, censored for death, acute rejection, thrombosis, infection, surgical complications, or recurrent disease. A Cox proportional hazard model correcting for 15 possible confounding factors evaluated the relative impact of AR on CAF. The era effect (years 1988-1989, 1990-1991, 1992-1993, 1994-1995 and 1996-1997) was evaluated by an era versus AR interaction term. Results. An AR episode within the first 6 months after transplantation was the most important risk factor for subsequent CAF (RR=2.4, CI 2.3-2.5). Compared with the reference group (1988-89 with no rejection), having an AR episode in 1988-89, 1990-1991, 1992-1993, 1994-1995, and 1996-1997, conferred a 1.67, 2.35, 3.4, 4.98 and 5.2-fold relative risk for the subsequent development of CAF (P <0.001). Conclusions. Independently of known confounding variables, the impact of AR on CAF has significantly increased from 1988 to 1997. This effect may in part explain the relative lack of improvements in long term renal allograft survival, despite a decline in AR rates.

AB - Background. Acute rejection (AR) remains a major risk factor for the development of chronic renal allograft failure (CAF), which is a major cause of late graft loss. With the introduction of several newer immunosuppressive agents (e.g., mycophenolate mofetil, tacrolimus and neoral) acute rejection rates have been steadily decreasing. However, the incidence of CAF has not decreased as dramatically as the incidence of acute rejection. One possible explanation is that the impact of AR on CAF is changing. The goal of this study was to analyze the relative impact of AR era on the development of CAF. Methods. We evaluated 63,045 primary renal transplant recipients reported to the USRDS from 1988 to 1997. CAF was defined as graft loss after 6 months posttransplantation, censored for death, acute rejection, thrombosis, infection, surgical complications, or recurrent disease. A Cox proportional hazard model correcting for 15 possible confounding factors evaluated the relative impact of AR on CAF. The era effect (years 1988-1989, 1990-1991, 1992-1993, 1994-1995 and 1996-1997) was evaluated by an era versus AR interaction term. Results. An AR episode within the first 6 months after transplantation was the most important risk factor for subsequent CAF (RR=2.4, CI 2.3-2.5). Compared with the reference group (1988-89 with no rejection), having an AR episode in 1988-89, 1990-1991, 1992-1993, 1994-1995, and 1996-1997, conferred a 1.67, 2.35, 3.4, 4.98 and 5.2-fold relative risk for the subsequent development of CAF (P <0.001). Conclusions. Independently of known confounding variables, the impact of AR on CAF has significantly increased from 1988 to 1997. This effect may in part explain the relative lack of improvements in long term renal allograft survival, despite a decline in AR rates.

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