Acute rejection episodes and long-term transplant function.

From 1974 to 1976, 114 kidneys transplanted to 108 patients underwent acute rejection episodes. With repeated rejections there was an increased likelihood of recovery without subsequent rejections, eg, 59% of kidneys that had three rejections regained prolonged good function. Repetitive rejections did not increase mortality. Discriminate analysis of the best serum creatinine level or creatinine clearance within 30 days of rejection and the time interval between rejection episodes correctly predicted the outcome of second rejections in 20/25 cases and correctly predicted the outcome of third rejections in 23/29 cases. Treatment of a third rejection was successful in 70% of kidneys if the best serum creatinine level was less than 2 mg/dL after the second rejection and was successful in 77% of kidneys if the time interval between second and third rejections was longer than one month.