Allograft rejection in kidney transplantation – A retrospective study of impact on graft and patient outcome

Abstract

Background: Renal allograft rejection is a major cause of graft dysfunction, and it is a predictor of long-term allograft loss. Advances in immunosuppression have decreased the influence of acute rejection on graft survival. In this study, we assessed clinicopathological profile and immediate and long-term treatment outcomes of different types of allograft rejections in our institute. Materials and Methods: We retrospectively analyzed patients who underwent renal transplantation and had biopsy-proven renal allograft rejections from January 2010 to December 2019 in our institute. Recipient–donor characteristics at the time of transplantation and graft function post transplantation were documented. Patients were followed up till graft loss or patient loss or a minimum 12-month period after rejection episode for all survived patients. Results: Allograft rejection occurred in 88/424 (20.75%) renal transplant recipients during the study period. Active antibody-mediated rejection (ABMR) was the most common type of rejection (40.9%) and was common in early posttransplant period also (54.5%). Graft dysfunction was the dominant presentation in all groups except chronic active ABMR, where heavy proteinuria was common. Chronic active ABMR was common (37.5%) in second episode of rejection. Overall graft survival, death-censored graft survival, and patient survival at the end of the study were 52.27%, 82.95%, and 69.3%, respectively. Conclusion: Renal allograft rejection decreases both graft and patient survival. Hence recommend regular surveillance for early detection and treatment.

Keywords

• allograft rejection
• antibody-mediated rejection
• graft survival