Risk Factors for Chronic Rejection after Renal Transplantation

Cho, Seog Ju; Kwon, Oh Jung; Kwak, Jin Young; Kang, Chong Myung

Abstract

PURPOSE: Chronic allograft nephropathy is the most common cause of renal transplant failure in the first post-transplant decade, but its pathogenesis has remained unclear. The most effective option to prevent chronic allograft nephropathy is the prevention of graft injury from both immune and non-immune mechanisms. To prevent chronic allograft rejection as avoiding high risk factors in donor selection, we analyzed the potential risk factors of chronic allograft rejection in renal transplantation.
METHODS
Retrospective review was performed on clinical courses of 592 recipients of renal transplantation treated with cyclosporine, azathioprine or mycophenolate mofetile and prednisone from January, 1985 to December, 2000 in Hanyang University Hospital. Of 592 cases, chronic rejection was occurred in 51 cases, we analysed this group. The control group was demographically matched using the parameters of age, gender, date of transplantation, and immunosuppressive protocol, the numbers of control group was 98 cases in same period. We compared with two groups for risk factors, such as donor age, HLA mismatching, acute rejection episode and frequency, and proteinuria at 1 month after transplantation. We identified statistical analysis using univariate logistic regression analysis with SPSS program. The data comparison was performed through chi-square test.
RESULTS
The average age of recipient is 33.8 years and that of donor is 45.5 years in chronic rejection group. Acute rejection episode was 51% (26/51) compared with control group 10.2% (10/98). Univariate analysis of risk factors revealed that acute rejection episode (P=0.000), HLA-DR mismatching (P=0.000), and donor age (P=0.000) were significant independent risk factors.
CONCLUSION
We suggested that acute rejection episode, over 50 years of donor age and the degree of HLA-DR mismatching were the risk factors of chronic rejection. And so, in selecting donor for living donor renal transplantation, we should concern donor age, HLA-DR mismatching, and aggressive treatment in occurring acute rejection episode after transplantation.