Korean J Transplant.  2022 Nov;36(Supple 1):S200. 10.4285/ATW2022.F-3342.

Acute rejection associated with short-term and long-term survival in kidney transplantation: a single center study in Indonesia

• Prabu OG
• Hustrini NM
• H. Marbun MB
• Septianto T
• Indriani A
• Septiar D
• Lydia A
• Nugroho P
• Susalit E

• KMID: 2535265
• DOI: http://doi.org/10.4285/ATW2022.F-3342

Abstract

Background
Acute transplant rejection is proven to have significant impact on the graft and patients' survival. This study aims to evaluate the short- and long-term outcomes of acute rejection in the largest kidney transplant (KT) center in Indonesia.
Methods
Retrospective cohort study was conducted at Dr. Cipto Mangunkusumo National General Hospital, Jakarta. We recruited all recipients of living-donation kidney transplantation from 2011 to 2016. All-cause graft survival and patient survival rate were analyzed and its association with acute rejection rate. Kaplan-Meier, log-rank, Cox regression and logistic regression were used for statistical analysis.
Results
A total of 344 subjects were included in this study. Most of the recipients were male (69.5%), with a mean age of 47.65±13.05 years. Acute rejection rate was identified in 5.6% of patients. The 5-year all-cause graft survival rate was 68.9% and 5-year patient survival after KT was 72.4%. While the 1-year, 3-year, and 5-year all-cause graft-survival rate in subjects developing acute rejection was 10.5%, 5.3%, and 0%, respectively. Furthermore, the 1-year, 3-year, and 5-year patient survival rate in acute rejection was 21.1%, 15.86%, and 10.5%, respectively. We found a significant correlation of acute rejection episodes with the 1-year, 3-year, and 5-year graft survival and patient survival (P<0.001). Mean survival time in acute rejection subjects was 13.22 (3.03–23.42) months. Acute rejection was independently associated with 5-year all-cause graft survival (hazard ratio [HR], 6.96; 95% confidence interval [CI], 3.79–12.79; P<0.001) and 5-year patient survival (HR, 4.15; 95% CI, 2.26–7.6; P<0.001) after KT. Further analysis on the risk factors of acute rejection demonstrated that duration of dialysis >3 years before KT was associated with acute rejection (adjusted HR, 7.11; 95% CI, 2.72–18.6).
Conclusions
Acute rejection is associated with short-term and long-term graft survival and patients survival in KT. Early diagnosis of acute transplant rejection and heightened monitoring may make graft preservation feasible.