From acute to chronic rejection after kidney transplantation

Abstract

Increased frequency of acute rejection episodes is the best predictor for the development of an chonic rejection process in kidney transplantation. An effective antirejection therapy is critical to prevent transplant failure due to chronic rejection. The relationship between acute and chronic rejection is determined by the number of rejection episodes, clinical and histological grading, timing, residual function and individual problems of donor and recipient. Standard immunosuppression with calcineurin inhibitors such as cyclosporine or tacrolimus and antiproliferative substances such as azathioprine or mycophenolatemofetile have to be intensified when an acute rejection episode occurs. For maximal immunosuppression antibody preparations such as ATG and OKT3 in combination with with a short course of steroid pulse therapy are available. In this review we summarize the clinical implications and therapeutic consequences of the relationship between acute and chronic rejection. The acute rejection episode has still a great impact on long-term graft outcome which may only be improved by a prompt treatment of initial acute rejection episodes.