DETERMINANTS OF RECURRENT ACUTE REJECTION IN KIDNEY TRANSPLANT RECIPIENTS

Abstract

312 Recipients with recurrent (>1) acute rejection (AR) episodes have significantly lower graft survival rates versus those with no AR or only 1 treated episode (Graph 1). However, less than 50% of recipients treated for 1 AR episode will have another episode. We studied recipients with at least 1 AR episode to determine if any clinical features could identify risk factors for recurrent AR. Between 1/01/84 and 6/30/97, 1793 recipients underwent kidney transplant; of these, 354 were treated for 1 AR episode, 307 for greater than 1. By multivariate analysis, recipients at highest risk for recurrent AR were those with initial delayed or slow graft function (RR = 1.5, p=0.05), those with initially severe AR (as judged by vascular involvement or steroid resistance), and those with an initial early AR episode (<6 months posttransplant). The remaining variables tested were not significant (Table). Graft survival in recipients with greater than 1 AR episode was significantly lower versus those with only 1 AR episode (Graph, p=0.0001). (Figure)TableFigureConclusion: Clinical features may be used to identify recipients at higher risk for recurrent AR episodes. They can then be targeted with more aggressive or novel immunosuppression regimens in an attempt to reduce the likelihood of another AR episode.