Renal transplantationAcute rejectionFactors Contributing to Acute Rejection in Renal Transplantation: The Role of Noncompliance
Section snippets
Methods
We studied all kidney transplant recipients at Rhode Island Hospital who received a kidney between March 1997 and June 2004. The patients were tracked through a prospective institutional database, which contained all episodes of rejection. Acute rejection was uniformly confirmed by kidney allograft biopsy, interpreted by a renal pathologist. The time from transplantation to the first episode of acute rejection was calculated. Repeat episodes of acute rejection, occurring in 15 of 87 patients,
Results
The study included 443 patients whose allografts survived greater than 30 days after transplantation. The mean patient follow-up was 44 ± 24 months (range 12–94 months), while the mean allograft survival was 41 ± 23 months. Eighty-seven patients (20%) suffered 107 episodes of acute rejection, including 47 (11%) in the first 6 months after transplantation. Fifteen patients had two or more episodes, with 10 of these confined to the first 6 months after transplantation. The incidence of acute
Discussion
Several factors increase the risk of acute rejection, including young recipient age, low levels of immunosuppression, DGF, prior sensitization to antihuman leukocyte antibodies, and patient nonadherence to immunosuppression.3 Following successful engraftment, renal transplantation requires lifelong immunosuppression, necessitating indefinite, twice daily drug therapy. The drug regimens are costly and associated with a broad spectrum of unpleasant side effects. As a result, approximately 20% to
References (14)
- et al.
Am J Transplant
(2003) - et al.
Am J Transplant
(2004) - et al.
Transplantation
(1997) - et al.
Transplantation
(1994) - et al.
Compliance and noncompliance in patients with a functioning renal transplant, a multicenter study
Transplantation
(1998) - et al.
Transplant Proc
(1999) - et al.
Transplantation
(2004)
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