15th Congress of the Asian Society of TransplantationRenal transplantationRisk Factors for Acute Rejection After Deceased Donor Kidney Transplantation in China
Section snippets
Methods
Adult patients (≥18 years) receiving kidney transplantation from deceased donors in our center from February 2004 to December 2015 were enrolled for retrospective analysis. All deceased donations complied with China's Organ Donation Program. No organs from executed prisoners were used [2]. Acute rejection was suspected when serum creatinine increased by over 20% in 72 hours. Biopsy-proven acute rejection (BPAR) was classified according to the Banff criteria by the local pathologist. Clinical
Results
There were 524 recipients enrolled for analysis. The demographics and clinical characteristics of donors and recipients were listed in Tables 1 and 2. Within the sensitized recipients with positive PRA (n = 41), only 2 contained pre-existing donor-specific antibodies; the others were third-party sensitized. Fifty-five recipients experienced 63 episodes of acute rejection (55/524, 10.5%). Seven recipients experienced 2 episodes and 1 recipient experienced 3 episodes. There were 11 episodes of T
Discussion
In our study, we identified 4 risk factors of acute rejection after deceased kidney transplantation: longer pre-transplant dialysis duration, positive pre-transplant PRA, a higher number of HLA mismatches, and weaker maintenance immunosuppression (cyclosporine). These results confirm those of previous studies [8], [9], [10]. However, the effect of prolonged cold ischemia time on acute rejection was not identified in our study as in others [8], [11]. Mikhalski et al showed a significantly
Conclusion
Longer pre-transplant dialysis duration, HLA mismatch, and positive pre-transplant PRA increase the risk of acute rejection, while tacrolimus facilitates prevention of acute rejection compared to cyclosporine in deceased donor kidney transplantation.
Acknowledgements
This work was supported by the Natural Science Foundation of China (Grant nos. 81670680, 81300623, and 81700655), the Science and Technology Planning Project of Guangdong Province, China (Grant nos. 2015B020226002, 2014B020212006, 2013B021800292, and 2014A020212719), the Natural Science Foundation of Guangdong Province (Grant nos. 2015A030313135 and 2014A030313022), the Science and Technology Program of Guangzhou, China (Grant no. 2014Y2-00114), and the Guangdong Provincial Key Laboratory on
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Gene polymorphisms and risk of acute renal graft rejection: A field synopsis of meta-analyses and genome-wide association studies
2020, Transplantation ReviewsCitation Excerpt :Despite major advances in the field of immunosuppressive therapy, acute rejection still remains the primary challenge following kidney transplantation [1], being a major risk factor for chronic allograft dysfunction and long-term graft loss [2,3]. A wide number of clinical and environmental factors have been reported to influence development of acute renal graft rejection, including recipient's age and ethnicity, pre-transplant dialysis duration, delayed graft function, degree of immunosuppression and development of donor-specific antibodies [4–6]. Among genetic predictors, human leukocyte antigens (HLA) matching status between donor and recipient is the most important factor that influences graft outcomes after kidney transplantation [7,8], however the contribution of genetic variants in other genes remains uncertain.
Late impact of preformed anti-HLA antibodies on kidney graft outcome
2019, Transplant ImmunologyCitation Excerpt :They also found that a higher number of HLA mismatches independently predicted acute rejection (OR 1.65 for each increase in the number of mismatches; 95% CI: 1.15 to 2.38; p = 0.007), and that episodes in the first year after transplantation were associated with a significantly lower death-censored graft survival (63.5% vs. 91.2%; p < 0.0001) [25]. Although previous studies suggested the association between PRA >0% and increased risk of acute rejection and graft loss [26–28], we believe that in our study, the correlation between class I and class II PRA >80% and graft loss may be because of DSAs not recognized at the time of transplant probably due to antibodies anti-HLA C and DQ. As stated above 38% of donors came from centers who do not perform these typings.
Long-Term Follow-up Results of Renal Transplantation in Pediatric Patients With Focal Segmental Glomerulosclerosis: A Single-Center Experience
2019, Transplantation ProceedingsCitation Excerpt :This may be the consequence of calcineurin inhibitors being administered to all patients in this group. Longer pre-transplant dialysis duration, HLA mismatch, and high pre-transplant panel-reactive antibody levels are reported as risk factors for acute rejection [20,21]. According to Cox regression analysis, variables such as HLA mismatch, warm and cold ischemia times, donor age and sex, age at ESRD, and duration of dialysis affecting rejection were also not significant.
AIM2 as a putative target in acute kidney graft rejection
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The first 3 authors contributed equally to this work.