Kidney allograft survival and risk factors after treating biopsy proven acute rejection among kidney transplant patients
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Abstract
Background: Acute rejection is a common complication in kidney transplantation (KT) and is associated with reduced graft survival. However, information of long term allograft survival and its related factors after treating acute rejection remains limited. Therefore, this study aimed to evaluate renal allograft survival after treating acute rejection.
Methods: The retrospective study was conducted among postkidney transplant patients. After receiving a diagnosis for acute rejection, they were treated between January 2013 and January 2019 in Srinagarind Hospital. Graft and patient survivals were analyzed and presented using Kaplan-Meier curves and demonstrating significance using the Log- rank test. Cox regression analysis was used to identify independent prognostic variables and to estimate hazard ratios.
Results: A total of 89 patients (63 acute antibody-mediated rejection, 10 acute cellular rejection and 16 combined rejections) were recruited. Overall incidence rate of graft loss and return to dialysis was 8.2 per 1000 patient-months (2.9 per 1000 patient-months in the clinical response vs. 15.6 per 1000 patient-months in the nonresponse group). The overall graft and patient survival rates were 85.2 and 92.1% at 1 year (100 and 100% in the clinical response vs. 74.8 and 86.8% in the nonresponse group) and 68.6 and 85.4% at 5 years (82.9 and 96.4% in the clinical response vs. 61.3 and 77.9% in the nonresponse group). Multivariate analysis demonstrated factors associated with graft loss included being in the clinical response group (Hazard ratio: HR 0.09, 95% confidence interval (CI) 0.009-0.93, P=0.04), history of repeated treatment for rejection (HR 6.8, 95% CI 1.41-33.1, p = 0.017), tacrolimus concentration (increase every 1 ng/mL) at week 24 post rejection treatment (HR 0.65, 95% CI 0.44 – 0.95, P=0.02) and recurrence of glomerular disease (HR 26.4, 95% CI 2.46–283, P=0.007). Factors related to patient survival included being in the clinical response group (HR 0.08, 95% CI 0.007-0.85, P=0.036), recurrence of glomerular disease (HR 14.9, 95% CI 3.37–65.6, p <0.001) and occurrence of malignancy (HR 5.6, 95% CI 1.04 – 30.3, P=0.04).
Conclusion: Acute rejection episodes significantly worsened renal allograft and patient survival rates. Maintaining tacrolimus concentration at appropriate levels after treating rejection should be further investigated. Additionally, recurrence of glomerular diseases and malignancy also had major effects on survival of allograft-rejected patients. Therefore, physicians should regularly monitor and promptly treat patients to improve survival.
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