Volume : V, Issue : V, May - 2015

Late acute rejection in long–term renal allograft recipients : response to corticosteroid therapy

Dr. Ji Shu Ming

Abstract :

 Objective: The purpose of this stusy was to investigate clinical profile and course and outcome of late  acute rejection episodes in cadaveric donor renal allograft recipients. Methods: We prospectively monitored clinical data and renal function at monthly intervals in 440 patients who had received renal allograft transplants at  our institution. All had functioning allograft for 1 year or longer. Eighty–three cases of late acute rejection in our center  have been clinically observed and analyzed in this study. Results: During a mean follow–up period of 43.6(range 1364) months,83 patients(18.9%) developed late acute rejections. Of these 83 late acute rejections, as many as 87.9%  showed a respone to antirejection therapy with high–dose steroids:23(27.7%) a complete respone and 50(60.2%) a partial response. The response rate was 100% if it was the first acute rejection(35.2% complete and 64.8% partial),81.0%,  if it was the second (19.1% complete and 61.9% partial),and no or only a partial response to treatment if it was the  third acute rejection episode. Following antirejection therapy,17 of acute cellular rejection (54.8%) were reversed  completely,a partial response was obtained in 14(45.2%). Forty–tow patients showed histological features of acute celular rejection plus chronic rejection. Of these,6(14.3%) were reversed with antirejection therapy, a partial response was  obtained in 34(81.0%),and no response in 2(4.8%).Ten rejection showed histological evidence of chronic rejection. Of  these, only 2(20.0%) had responded partially to antirejection therapy;8(80%) did not respond.On long–term follow–up,  patients who had responseed to antirejection treatment had a significantly better graft survival as compared with nonresponding patients:72.0 and 23.0%, respectively. Conclusion: Renal histology provides valuable diagnostic and prognostic information in the management of patients with late allograft rejection. The chances of a response to antirejection therapy are higher during the first episode of late acute transplant rejection as compared with a second or a third  late rejection event. 

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Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Dr. Ji Shu-Ming Late acute rejection in long–term renal allograft recipients : response to corticosteroid therapy Indian Journal of Applied Research, Vol.5, Issue : 5 May 2015

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