Graft Survival In Renal Transplantation Research Articles

Changes in Numbers of Glomerular Macrophages Between Two Consecutive Biopsies and the Association With Renal Transplant Graft Survival.

Macrophages are involved in kidney transplants. The aim of the study was to investigate if changes exist in the levels of glomerular macrophage index (GMI) between two consecutive kidney transplant biopsies, and if so to determine their potential impact on graft survival. Two consecutive biopsies were performed on the same renal graft in 623 patients. GMI was categorized into three GMI classes: ≤1.8 Low, 1.9-4.5 Medium, and ≥4.6 High. This division yielded nine possible switches between the first and second biopsies (Low-Low, Low-Medium, etc.). Cox-regressions were used and hazard ratios (HR) with 95% confidence interval (CI) are presented. The worst graft survival was observed in the High-High group, and the best graft survival was observed in the Low-Low and High-Low groups. Compared to the High-High group, a reduction of risk was observed in nearly all other decreasing groups (reductions between 65% and 80% of graft loss). After adjustment for covariates, the risk for graft-loss was lower in the Low-Low (HR = 0.24, CI 0.13-0.46), Low-Medium (HR = 0.25, CI 0.11-0.55), Medium-Low (HR = 0.29, CI 0.11-0.77), and the High-Low GMI (HR = 0.31, CI 0.10-0.98) groups compared to the High-High group as the reference. GMI may change dynamically, and the latest finding is of most prognostic importance. GMI should be considered in all evaluations of biopsy findings since high or increasing GMI levels are associated with shorter graft survival. Future studies need to consider therapeutic strategies to lower or maintain a low GMI. A high GMI besides a vague histological finding should be considered as a warning sign requiring more frequent clinical follow up.

Renal Transplants Due to Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) Have Better Graft Survival Than Non-CAKUT Controls: Analysis of Over 10,000 Patients

To determine whether graft survival for patients with congenital anomalies of the kidney and urinary tract (CAKUT) is impaired compared to non-CAKUT counterparts. The United States Renal Data System (USRDS) is a national data system that has collected information about end stage renal disease (ESRD) and renal transplantation since 1995. We identified 10,635 first-time renal transplant patients with ESRD attributed to a CAKUT diagnosis transplanted between 1995 and 2018, with follow-up of 7.9 ± 5.8 years. We matched 1:1 with non-CAKUT transplant recipients, using age at transplant, sex, race, year of transplant, and donor-type. We compared renal transplant death-censored graft survival between CAKUT vs non-CAKUT controls, with further stratification for age at transplant and lower urinary tract malformations (LUTM) vs upper urinary tract malformations (UUTM). Graft survival was better in CAKUT patients with a 5-year survival of 83.3% vs 79.3% (P< .001), and CAKUT status infers a hazard ratio of 0.878 for graft failure on multivariable analysis with Cox regression. Favorability of CAKUT status persisted when stratifying for both pediatric (80.3 vs 77.6% P< .001) and adult (84.5 vs 81.4% P< .001) age groups. Looking within the CAKUT population: comparison of LUTM to UUTM yielded no difference, implying that LUTM is not a risk factor for graft failure. Examining pediatric LUTM alone, graft survival was not better than matched non-CAKUT counterparts with 5-year graft survival of 69%-75% for LUTM adolescents. Renal transplant graft survival is better overall in CAKUT patients as opposed to non-CAKUT counterparts. Pediatric LUTM patients have similar graft survival to controls.

Essential updates 2018/2019: Liver transplantation.

Among the recent topics in the field of liver transplantation (LT), one of the significant therapeutic breakthroughs is the introduction of direct‐acting antiviral agents (DAAs) against hepatitis C virus (HCV) infection. With cure rates close to 100%, a better proportion of LT candidates and recipients can be cured of HCV infection by DAA therapies that are simple and well‐tolerated. Other critical topics include the issue of indication of LT for patients with hepatocellular carcinoma, which has been continuously studied. Several expanded criteria beyond the Milan criteria with acceptable results have been recently reported. The role of donor‐specific antibodies (DSAs) in intractable rejection is also an important matter that has been studied. Although long recognized as an important factor in antibody‐mediated rejection and even graft survival in renal transplantation, the impact of DSAs on graft and patient survival in LT remains to be elucidated. Including the issues described above, this article focuses on recent advances in LT, management to avoid recurrence of primary diseases, optimization of immunosuppressive treatment, and extended donor criteria.

Prognostic factors for renal transplant graft survival in a retrospective cohort of 1000 cases: The role of desensitization therapy

To review the results of renal transplantation after promulgation of the Human Organ Transplant Act in Taiwan in 1987, we conducted a retrospective study in the first 1000 cases performed in our hospital. Prognostic factors for graft survival were assessed with emphasis on the impact of donor-specific antibody (DSA). Between January 1988 and April 2014, there were 1000 cases of renal transplantation performed in our hospital. Excluding 30 patients of ABO-incompatible transplantation, we reviewed 970 cases of ABO-compatible renal transplantation to analyze the prognostic factors for graft survival. The patients were grouped according to the dates of operations before (the Early group: 503 cases) and after (the Late group: 467 cases) the introduction of detection and desensitization of alloantibody in our hospital in 2004. The overall 5-year graft survival rate were 82.6%, which was significantly lower in the Early group (79.2%) than the Late group (86.3%) (p=0.0012). The 1-year rejection-free survival was significantly lower in the Early group (78.3%) than the Late group (91.2%) (p=0.0165). The difference between the two groups became insignificant when the time of observation extended beyond 12 months. In a multivariate regression model, we identified significant factors for poor graft survival, including HLA mismatches, delayed graft function with or without recovery, and antibody-mediate rejection (AMR). HLA mismatches, delayed graft function with or without recovery, and AMRwere significant factors for poor graft survival. Detection and desensitization of DSA currently might be inadequate to improve the long-term outcome of renal transplantation.

Tacrolimus Variability: A Cause of Donor-Specific Anti-HLA Antibody Formation in Children.

The most important determinant of long-term graft survival in renal transplantation is adequate immunosuppression. Inadequate immunosuppression may lead to graft loss due to the presence of anti-HLA antibody. The aim of this study was to investigate the effect of variability in tacrolimus blood concentration on anti-HLA antibody development in pediatric recipients of living-donor renal transplants. Pediatric recipients of living-donor renal transplants were retrospectively evaluated. Patients with a minimum of two years of follow-up who were administered tacrolimus were included in the study. Patients who had pretransplant anti-HLA antibody were excluded. Variability in tacrolimus blood concentration was assessed using the coefficient of variation ("tacrolimus CV") method. Tacrolimus CV was calculated separately for the first 6months post-transplant, between 6 and 12months post-transplant, and from the end of the first year post-transplant to the last follow-up. We constructed receiver operating characteristic (ROC) curves of the tacrolimus CV for each group to find the best cutoff value. A total of 67 patients (including 48 males; 72%) with a mean age of 15.16 ± 4.43years were included in the study. Anti-HLA antibody positivity was detected in 12 patients (18%). More than three HLA mismatches and the presence of acute cellular rejection correlated with the development of anti-HLA antibody (p = 0.056, 0.009). Tacrolimus CVs for the three periods were 0.37 ± 0.11, 0.31 ± 0.18, and 0.35 ± 0.12, respectively. The cutoff value of tacrolimus CV for anti-HLA antibody development was calculated as 0.32 with a sensitivity of 90.91% and specificity of 50.94% [AUC (area under the curve) 0.713, p = 0.023]. During the second 6-month period and after a year post-transplant, the percentage of patients with tacrolimus CV >0.32 was significantly higher in the anti-HLA antibody positive group than in the antibody negative group (67% vs 31%, p = 0.027; 83% vs 47%, p = 0.033). The eGFR (estimated glomerular filtration rate) was similar for the anti-HLA antibody negative and positive groups (78.72 ± 2.86 vs 77.45 ± 8.08, p > 0.05). High tacrolimus concentration variability appears to be associated with anti-HLAantibody formation in pediatric recipients of living-donor renal transplants.

An adjustable predictive score of graft survival in kidney transplant patients and the levels of risk linked to de novo donor-specific anti-HLA antibodies.

Most predictive models and scores of graft survival in renal transplantation include factors known before transplant or at the end of the first year. They cannot be updated thereafter, even in patients developing donor-specific anti-HLA antibodies and acute rejection.We developed a conditional and adjustable score for prediction of graft failure (AdGFS) up to 10 years post-transplantation in 664 kidney transplant patients. AdGFS was externally validated and calibrated in 896 kidney transplant patients.The final model included five baseline factors (pretransplant non donor-specific anti-HLA antibodies, donor age, serum creatinine measured at 1 year, longitudinal serum creatinine clusters during the first year, proteinuria measured at 1 year), and two predictors updated over time (de novo donor-specific anti-HLA antibodies and first acute rejection). AdGFS was able to stratify patients into four risk-groups, at different post-transplantation times. It showed good discrimination (time-dependent ROC curve at ten years: 0.83 (CI95% 0.76–0.89).

Effect of HLA Matching on Pediatric Renal Transplant Graft Survival in China

IntroductionKidney transplantation (KTX) has become one of the most effective therapies of choice for pediatric patients with end-stage renal disease (ESRD). The extent to which HLA mismatching influences graft survival following KTX has not been clarified. Patients and MethodsThe effect of HLA amino acid residue matching on graft survival was assessed in 36 pediatric patients in whom complete donor-recipient HLA data were available. HLA-A, -B, -DR and HLA-A+B+DR loci residue mismatches were separately analyzed. ResultsHLA-A, -B, -DR residue mismatches showed no significant statistical differences on kidney graft survival probability. When analyzing HLA-A+B+DR loci residue mismatches, the presence of 3 to 4 residue mismatches significantly increased the relative risk of graft rejection (P = .0292).

Deceased donor renal transplant graft survival – A single center experience

The Disease Activity Score (DAS) in rheumatoid arthritis (RA) involving 28 joints and using erythrocyte stimulation rate (ESR) is used frequently. But the inability of DAS 28 ESR to reflect short-term changes in disease activity has given rise to DAS 28 using C-reactive protein (CRP). The objective of the present study was to compare DAS 28 CRP with DAS 28 ESR.294 patients of RA diagnosed as per ACR EULAR 2010 revised classification criteria for RA were included. New cutoff values of remission, low, moderate and high disease activity using DAS 28 CRP were defined.There was a good correlation between DAS 28 ESR and DAS 28 CRP. On classifying the disease activity of the subjects according to new cutoff values of DAS 28 CRP, there was substantial agreement with classification according to DAS 28 ESR.DAS 28 CRP may be considered as an alternative to DAS 28 ESR.

Renal Transplantation and Outcome.

Emergency surgery represents an independent risk factor for death and postoperative complications. The aim of this study was to investigate the literature data regarding outcome of daytime or nighttime renal transplantation surgery. Relevant papers, focused on renal transplantation surgery, time of the day, and complications, were searched across the PubMed database. We used the following search terms: "renal", "transplantation", "surgery", "daytime", "nighttime", and "outcome". A total of five papers, including 6,991 adult patients were evaluated. All patients received renal transplantation from deceased donor. Daytime or nighttime surgery do not seem to negatively impact on graft survival in renal transplantation. However, two out five studies reported higher odds of complications after nighttime operation. Since it is not possible to predict the availability of a deceased donor, nighttime surgery remains a valid option when necessary, maybe deserving a higher level of caution to reduce or avoid complications.

A case report of recurrent C3 glomerulonephritis 18 months after renal transplantation

The recurrence of glomerulonephritis (GN) is critical to the prognosis of long-term renal transplant graft survival. C3 GN is a rare GN with a poor prognosis, and there are only a few reports of recurrent cases after renal transplantation. We recently experienced a case highly suspected of C3 GN recurrence. The patient was a 67-year-old male who had suffered from end-stage renal disease (ESRD) and started dialysis at the age of 60. His primary renal disease was unknown. At the age of 63, renal transplantation was successfully performed. His serum creatinine (Cr) level was maintained at 1.2 to 1.5 mg/dl, with no urinary protein or occult blood until 18 months after the transplant when urinary occult blood and protein became constant, along with an elevated Cr level at 1.5 to 1.6 mg/dl. The tentative diagnosis following a protocol biopsy at 36 months was dense-deposit disease. However, the pathological findings of an episode biopsy performed 1 year later, when his Cr level elevated to 2.0 mg/dl after varicella zoster virus reactivation, revealed no acute rejection but were compatible with C3 GN. These findings are consistent with a previous report on recurrent C3 GN that revealed relatively rapid loss of graft function, contrasting well with slow progression occurring in the native kidney. This case is possibly the first report in Japan of recurrent C3 GN after renal transplantation.

The impact of early and late acute rejection on graft survival in renal transplantation

BackgroundAdvances in immunosuppression after kidney transplantation have decreased the influence of early acute rejection (EAR) on graft survival. Several studies have suggested that late acute rejection (LAR) has a poorer effect on long-term graft survival than EAR. We investigated whether the timing of acute rejection (AR) influences graft survival, and analyzed the risk factors for EAR and LAR. MethodsWe performed a retrospective cohort study involving 709 patients who underwent kidney transplantation between 2000 and 2009 at the Samsung Medical Center, Seoul, Korea. Patients were divided into three groups: no AR, EAR, and LAR. EAR and LAR were defined as rejection before 1 year and after 1 year, respectively. Differences in graft survival between the three groups and risk factors of graft failure were analyzed. ResultsOf the 709 patients, 198 (30%) had biopsy-proven AR [EAR=152 patients (77%); LAR=46 patients (23%)]. A total of 65 transplants were lost. The 5-year graft survival rates were 97%, 89%, and 85% for patients with no AR, EAR, and LAR, respectively. These differences were significant (P<0.001 for both by log-rank test). In time-dependent Cox regression analysis, EAR (hazards ratio, 3.37; 95% confidence interval, 1.90–5.99) and LAR (hazards ratio, 5.32; 95% confidence interval, 2.65–10.69) were significantly related to graft failure. When we set LAR as standard and compared it with EAR, there was no statistical difference between EAR and LAR (P=0.21). ConclusionAR, regardless of its timing, significantly worsened graft survival. Treatments to reduce the incidence of AR and improve prognosis are needed.

One-year renal graft survival prediction using a weighted decision tree classifier

This study introduces a weighted decision tree algorithm for prediction of graft survival in renal transplantation using preoperative patient's data. The objective was to identify the preoperative attributes that affect the graft survival. Between the years 2000-2009, renal allotransplantation was carried out for 889 patients at Urology and Nephrology Center which is the subject matter of this study. The ID3 algorithm was chosen to build up the decision tree using the weka machine learning software. A modification was made on ID3 to refine the results. A weighted vector was introduced. The element of such a vector represents the weight of each attribute which was obtained by trial and error. The results indicated that the weighted algorithm was successful in predicting the graft survival after one year and identifying the attributes affecting graft survival. Keywords: Decision Tree, Data Mining, ID3 Algorithm, Graft Survival, Kidney Transplantation.

Patient and Graft Survival in Kidney Transplantation From Deceased Donors in Argentina, 1998-2011.

To analyze both patient and graft survival in renal transplantation in adults receiving kidneys from deceased donors in Argentina. 5181 transplants were included in the analysis. The information was taken from SINTRA 1st January 1998 until 31 December 2011 with follow-up to April 9, 2012. The Kaplan-Meier method was used to estimate survival, and time was divided in two-year and three year periods, as follows:1998-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2009, 2010-2011.Tocompare the curves the log-rank test was used. The Cox regression model was used to analyze the effect of variables like age and gender of both donor and recipient, donor's cause of death (stroke,TBI,anoxia,other causes of coma and others),time on dialysis (<or> 7 years ), cold ischemia time (<or> 24 hours) and etiology of recipient's renal failure. Patient survival for the period 1998-2000 at 1 year was 89.6%, at 3 years 86.4% and 81.8% at 5 years. For the period 2001-2003 at 1 year was 90.8%, at 3 years 85.1% and at 5 years 79%. 2004-2006, at 1 year was 89.2%, at 3 years 81%, and at 5 years 74.1%. 2007-2009, at 1 year was 90.1%, at 3 years 84%, and at 5 years 76.7%. 2009-2010, at 1 year was 90.2%. Log rank 0.0583. Graft survival 1998-2000 at 1 year was 88.2%, at 3 years 82.1%, and at 5 years 75%. 2001-2003, at 1 year was 87.5%, at 3 years 79.5%, and at 5 years 70.8%. 2004-2006, at 1 year was 82.9%, at 3 years 72.1%, and at 5 years 62.5%. 2007-2009, at 1 year was 86%, at 3 years 76.3%, and at 5 years 66.3%. 2009-2010, at 1 year was 86.1%. Logrank 0.0004. The variables with statistical significance for graft survival were recipient's age 45-59 years HR 1.38 (1.22-1.57)> 60 years HR 1.90 (1.65-2.19), donor's age 45-59 years HR 1.22 (1.08-1.39)> 60 years HR 1.60 (1.34-1.91), time on dialysis> 7 years HR 1.31 (1.17-1.48), CIT>24hrs HR 1.13 (1.01-1.25), diabetic nephropathy as a cause of CRF HR 1.62 (1.31-2.01) A significant difference in graft survival curves with improved survival for the first three time periods was observed. Once the variables associated with a lower probability of survival were found the comparison of proportions showed that in the last period, 2010-2011, more recipients over> 60 years of age received a transplant, with more donors> 60 years and with more recipients with more than 7 years on dialysis. The CIT <24 h was more common the period 2010-2011, but was not enough to change the differences in survival.

Acute Kidney Injury as a Risk Factor for Transplant Graft Failure

Acute kidney injury (AKI) has long-term biological effects on many organ systems and high mortality. Incomplete recovery of renal function from AKI is frequently observed, particularly when AKI is superimposed on chronic kidney disease (CKD), and this situation may further facilitate the progression of CKD. Patients with severe AKI in the intensive care unit typically have several failed extrarenal organ systems, including haemodynamic instability and respiratory failure. Consistent with these observations, AKI is associated with increased rates of graft failure and mortality after non-renal transplantation. For example, AKI is a common complication of liver transplantation and is associated with reduced patient and graft survival. AKI after lung transplantation also affects the clinical outcomes. The toxicity of calcineurin inhibitors, intraoperative hypoxemia, hypoperfusion due to diuretics overuse, and the use of antibiotics may be predisposing factors that leads to AKI after lung transplantation. While delayed graft function (DGF) caused by ischemic-reperfusion injury during the early phase of kidney transplantation affects graft function, pretransplantation AKI affecting donor kidneys may not have an adverse effect on long-term outcomes. Several biomarkers, such as gelatinase-associated lipocalin, have been evaluated for predicting DGF and long-term graft function; however, additional studies are required to establish the optimal use of these biomarkers. Recent studies also indicate that AKI during in the maintenance phase of kidney transplantation, frequently associated with sepsis and/or urinary tract infection, is a significant risk factor for graft failure. In this review, we focus on the impact of AKI on non-renal and renal transplant graft survival.

Gender differences in renal transplant graft survival

A long-term retrospective study was conducted to assess the risk factors of renal transplant graft failure focusing on the effects of gender of both the donor and the recipient. Medical records of primary renal transplantation performed in a single transplant hospital were reviewed. Cases of ABO incompatibility, positive cross-matches, or multiple organ transplants were excluded. A total of 766 patient records were reviewed, and variables were analyzed with Kaplan-Meier survival curves and Cox regression to determine the independent factors associated with graft survival. The overall 5-year graft and patient survival rates were 84.7% and 92.2%, respectively. Univariate analysis showed significantly poorer prognosis in male patients and in those with acute rejection, delayed function, or more mismatches in human lymphocyte antigens. Multivariate analysis with step-wise regression identified three independent prognostic factors for poor graft survival (male gender, acute rejection, and delayed function). The 5-year graft survival rates for female and male patients were 87.9% and 81.3%, respectively. The risk ratio of graft failure for male renal transplant recipients was 1.3732, when compared with that for female patients. The risk ratios for those with acute rejection and delayed function were 1.8330 and 1.5422, respectively. Male gender, in addition to acute rejection and delayed function, was found to be an independent prognostic factor for poor renal transplant survival in this long-term retrospective study.

Red cell and human leukocyte antigen alloimmunization in candidates for renal transplantation: a reality

Red cell and human leukocyte antigen alloimmunization in candidates for renal transplantation: a reality

Should Functioning AV Fistulas be Ligated after Renal Transplantation?

There is limited literature available to guide physicians on a course of action when they are approached by renal transplant recipients regarding the status of their vascular accesses. However, this is a frequent topic of discussion with these patients and there should be guidelines available to assist in the decision of whether to maintain or ligate an arteriovenous fistula (AVF) in a successful renal transplant patient. This review intends to present some of the literature, as well as to establish guidelines for management. The medical literature was reviewed and anecdotal information from our clinical experience was collected. Taking into account 10-year adjusted renal transplant graft survival rates, and the relative paucity of donors, it is possible that a successfully transplanted patient will have to return to dialysis at some point. After review of the literature, the impact of AVF ligation on the transplant patient's cardiac morphology and function is not clear. Patient and graft survival do not appear to be impacted by persistent AVFs. Emergent closure of the AVF might be required in cases of severe venous hypertension, risk of rupture from pseudoaneurysm, significant high output cardiac failure or ischemic hand. We recommend that following successful renal transplantation, functioning AVFs should almost never be ligated. Many patients require return to dialysis and the physiologic impact of the patent AVF on these patients does not strongly advocate routine ligation following transplant.

Five-Year Results of a Randomized Trial Comparing De Novo Sirolimus and Cyclosporine in Renal Transplantation: The Spiesser Study

Calcineurin inhibitors improve acute rejection rates and short-term graft survival in renal transplantation, but their continuous use may be deleterious. We evaluated the 5-year outcomes of sirolimus (SRL) versus cyclosporine (CsA) immunosuppressive treatment. This observational study was an extension of the SPIESSER study where deceased donor kidney transplant recipients were randomized before transplantation to a SRL- or CsA-based regimen and followed up 1 year. Data from 131 (63 SRL, 68 CsA) out of 133 patients living with a functional graft at 1 year were collected retrospectively at 5 years posttransplant. Seventy percent of CsA patients versus 54% of SRL patients were still on the allocated treatment at 5 years (p = 0.091), most discontinuations in each group being due to safety issues. In intent-to-treat, mean MDRD eGFR was higher with SRL: 54.2 versus 45.3 mL/min with CsA (p = 0.019); SRL advantage was greater in on-treatment analyses. There were no differences for patient survival (p = 0.873), graft survival (p = 0.121) and acute rejection (p = 0.284). Adverse events were more frequent with SRL (80% vs. 60%, p = 0.015). Results confirmed the high SRL discontinuation rate due to adverse events. Nevertheless, a benefit was evidenced on renal function in patients (more than 50%) still on treatment at 5 years.

Challenges and considerations in diagnosing the kidney disease in deteriorating graft function

SummaryDespite significant reductions in acute-rejection rates with the introduction of calcineurin inhibitor (CNI)-based immunosuppressive therapy, improvements in long-term graft survival in renal transplantation have been mixed. Improving long-term graft survival continues to present a major challenge in the management of kidney-transplant patients. CNIs are a key component of immunosuppressive therapy, and chronic CNI toxicity has been widely thought to be a major factor in late graft failure. However, recent studies examining the causes of late graft failure in detail have challenged this view, highlighting the importance of antibody-mediated rejection and other factors. In addition, the diagnosis of CNI nephrotoxicity represents a challenge to clinicians, with the potential for over-diagnosis and an inappropriate reduction in immunosuppressive therapy. When graft function is deteriorating, accurately determining the cause of the kidney disease is essential for effective long-term management of the patient. Diagnosis requires a thorough clinical investigation, and in the majority of cases a specific cause can be identified.

Role of Human Leukocyte Antigen, Donor-Specific Antibodies, and Their Impact in Renal Transplantation

IntroductionThe clinical significance of the presence of antibody against human leukocyte antigen (HLAb) and donor-specific antibodies (DSAb) prior to renal transplantation remains unclear. This study was done to assess the impact of HLAb and DSAb on graft function, rejection episodes, and graft survival in renal transplantation. MethodsThe Luminex (Luminex, Austin, Texas, United States) is a solid-phase assay using micro-spheres and it is more sensitive at detecting human leukocyte antigen (HLA) antibodies than conventional tests. This retrospective analysis involved 141 consecutive renal transplant recipients between May 2007 and 2009 and with a minimum of 2 years of follow-up. ResultsLuminex was positive for HLA class I in 35 and negative in 106; similarly class II positivity was noted in 23 and negative in 118. The DSAb were positive in 33 and negative in 108 recipients. The HLA class I, class II, and DSA-positive groups showed no difference in renal function assessed by estimated glomerular filtration rate (eGFR) at 2 years (52 ± 29 vs 52 ± 22; 56 ± 29 vs 51 ± 29; 48 ± 18 vs 53 ± 19; P = not significant [NS]). But rejection episodes at 1 year were significantly high in HLA class I and DSAb-positive group (17/35 vs 27/106; P = .019 and 16/33 vs 29/108; P = .035). The rejection episodes in the HLA class II–positive group did not show any difference when compared with the negative group (9/23 vs 40/118; P = .63). Graft survival was not affected by positivity to any of these antibodies at 2 years. ConclusionHaving HLA class I, class II, and DSAb does not have any influence on early and intermediate graft function. The HLA class I and DSAb positivity increases rejection episodes within 1 year in renal transplantation. Graft survival was not affected by class I, class II, and DSAb at 2 years.