Abstract
Objective: Dialysis or renal transplantation are the two treatment options for end-stage renal disease patients. Renal transplantation from an appropriate donor increases survival and quality of life compared to treatment with dialysis. Recent advances in immunosuppressive therapy have significantly improved the success in 1-year graft survival. However, the long-term graft survival remains the same. Therefore, we aimed to determine the underlying causes and risk factors of chronic allograft dysfunction in renal transplant recipients.
 Materials and Methods: From 2000 to 2012, all consecutive renal transplant recipients followed in our tertiary referral center who underwent renal biopsy due to an increase in serum creatinine level were enrolled. Etiologies of chronic allograft dysfunction were assessed according to pathologic results of renal biopsy specimens and laboratory findings. The immunological and non-immunological risk factors of chronic allograft dysfunction were screened and recorded retrospectively.
 Results: Eighty (80) renal transplant recipients with a mean age of 38±10 years were included in the study. Delayed graft function (p=0.007), history of acute rejection (p<0.001), positive panel reactive antibody (p=0.033) (Class I (p=0.013), Class II (p=0.006)), positive donor specific antibodies (p=0.001), number of recurrent acute rejections (p<0.001), number of human leukocyte antigens mismatches (p=0.051), cold ischemia time (p=0.001) were found to be risk factors for chronic allograft dysfunction. The donor specific antibodies positivity (p<0.001) and the panel reactive antibody positivity (Class I (p=0.003), Class II (p=0.001)) were significantly higher in patients with antibody mediated rejection than patients without antibody mediated rejection (p=0.002).
 Conclusion: Delayed graft function, presence and the number of acute rejections, increased cold ischemia time, panel reactive antibody positivity, donor specific antibodies positivity, and the number of human leukocyte antigens mismatches were risk factors for chronic allograft dysfunction.
Highlights
Chronic kidney disease (CKD) is a serious health problem increasing both patient morbidity and mortality
In the current study, delayed graft function, history and the number of acute rejections, duration of cold ischemia, presence of vascular involvement, panel reactive antibody (PRA) positivity (Class I and Class II), donor specific antibodies (DSA) positivity, increased number of human leukocyte antigens (HLA) mismatches were determined as risk factors for the development of chronic allograft dysfunction
In a study done by Woo et al including 32,557 renal transplantation (RT) recipients, the delayed graft function and increase in cold ischemia time were found to affect graft survival adversely, especially if the donors were older than 55 years [5]
Summary
Chronic kidney disease (CKD) is a serious health problem increasing both patient morbidity and mortality. It induces a heavy burden on the national economy [1]. In Turkey, there have been 83783 patients with CKD, and this amount is increasing progressively [2]. Prevention and management of CKD are of paramount importance [3]. The management of end-stage kidney disease is achieved with two distinct treatment modalities: dialysis and kidney transplantation [4]. Compared to the dialysis treatment, renal transplantation (RT) is better in improving life quality and patient outcomes if performed from a well-matched donor [5]. RT is currently the most appropriate treatment option for end-stage kidney disease
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