Renal graft survival in children with early acute rejection.

Acute rejection episodes (AREs) are an important cause of morbidity and mortality in children following renal transplantation. For the purpose of this study, the diagnosis of early rejection was established when it developed within the first 6 months post-transplantation. The impact of an early ARE on patient and graft survival areas was studied in 44 patients who received their grafts between January 1987 and December 1995. Group I (GI) was comprised of 25 patients who developed 30 ARE. They were compared to 19 age- and sex-matched controls without ARE, group II (GII), who were transplanted during the same time-period and received similar long-term immunosuppressive triple therapy, oral prednisone, azathioprine and cyclosporine A. The ARE was confirmed by renal biopsy in 83% of the cases. Morbidity, mortality and graft function were assessed statistically at baseline, 12 and 24 months after transplantation. Seven GI patients lost their grafts during an ARE; in 4 cases death that was related to opportunistic infections presenting during or soon after anti-rejection therapy, whereas 3 patients who survived lost their grafts due to thromboses or infections, also as a consequence of ARE. The GI graft survival rates were 76% and 72% at 12 and 24 months post-transplant, respectively, whereas the graft survival rate of GII patients was 100% at both evaluation periods. The patient survival rate was 84% in GI and 100% in GII patients at 24 months. No statistically significant differences of renal function were found between and/or within groups at 12 and 24 months. Recipients of living related donor (LRD) and cadaveric donor (CD) kidneys were evaluated independently of the group to which they were allocated. The acute rejection ratio (number of AREs/number of transplants) was 0.61 in LRD and 0.38 in CD (differences non-significant). This study concludes that AREs are an important cause of patient and graft loss, with opportunistic infections being a major threat to be considered during aggressive anti-rejection therapy. The renal function was normal after long-term follow-up in both groups of patients, regardless of ARE.