LONG-TERM FOLLOW-UP AFTER STEROID RESISTANT ACUTE RENAL ALLOGRAFT REJECTION

Abstract

P271 Aims: There exist few prospective data on the long-term outcome after steroid resistant renal allograft rejection. We performed this study to investigate long-term outcome of patients with steroid resistant renal allograft rejection and to identify factors predictive for long-term graft survival. Methods: 50 patients (mean age 42 ± 23 years, range from 21 to 65 years) with biopsy proven steroid resistant renal allograft rejection including 20 patients refractory to OKT3 treatment were prospectively evaluated for at least 5 years. All patients had their baseline immunosuppressive treatment switched from cyclosporine to tacrolimus. At the beginning of tacrolimus treatment 27 of these patients were dependent on dialysis. Results: The 3-year and 5-year patient survival rates were 98% and 92%, respectively, while 74% and 68% of renal allografts were functioning after 3 and 5 years. The mean serum creatinine concentrations were 1.84 ± 1.0 mg/dl (3 years) and 1.65 ± 0.7 mg/dl (5 years). There was one patient developing a seminoma that was cured by surgery and chemotherapy; no further malignancies developed during follow-up. The only parameter predictive for long-term graft survival was pre-treatment with OKT3 (3 years: 18/20 with OKT3 vs.19/30 without OKT3, p = 0.035; 5 years 18/20 with OKT3 vs. 16/30 without OKT3, p < 0.01). There was no significant difference in long-term graft survival between patients on dialysis vs. dialysis free patients at the beginning of tacrolimus treatment (3 years: 17/27 patients on dialysis vs. 20/23 free of dialysis; 5 years: 17/27 vs. 17/23, p = n.s.). Other parameters like patient and donor age, CMV-infection, histology score, tacrolimus trough levels, and delayed graft function were not predictive for outcome. Conclusions: Tacrolimus treatment of patients with steroid resistant renal allograft rejection leads to an acceptable long-term graft survival. OKT3 therapy prior to switching baseline immunosuppression to tacrolimus was associated with a favourable outcome.