We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Chronic renal allograft rejection can be predicted by area under the serum creatinine versus time curve (AUC<sub>Cr</sub>).
- Authors
Yilmaz, Serdar; Yilmaz, Asli; Häyry, Pekka
- Abstract
Acute rejection is the most important single risk factor (or chronic renal allograft rejection. Numerical quantitation of rejection episodes does not take into account the intensity and length of these episodes, both of which may contribute to the severity of chronic rejection. We propose a single numerical parameter for the frequency, intensity and length of acute rejections, the ‘Area Under the Serum Creatinine versus Time Curve’ (AUCCr) using renal allografts between inbred rat strains. Twenty-seven renal transplantations were performed from the DA to WF rat strain. The rats were immunosuppressed with 5 mg/kg body weight of CyA injected s.c. for 1, 2, 3 and 12 weeks, resulting in differing numbers (0–4) of biopsy-confirmed acute rejections of varying intensity (s-cre: 100–448 μmol/L) and length (3–24 days), all of which were reversed with additional CyA treatment. The intensity of chronic changes in graft histology was quantitated using the ‘Chronic Allograft Damage Index’ (CADI). End-point transplant function was quantitated as level of serum creatinine at sacrifice. The AUCCr from 0 to 3 weeks (AUCCr0–3), encompassing the recovery period after operation, free of rejections, did not correlate with the CADI (r = 0.230, P = 0.249). All AUCCr from 3 weeks onwards correlated with the CADI. The best correlation with the CADI was obtained with AUCCr from 3 to 12 weeks (AUCCr3–12) (r = 0.922. P = 0.0001). This interval coincides with the timing of all acute rejection episodes. AUCCr3–12 correlated equally well to end-point transplant function (r = 0.890, P = 0.0001). The correlations of AUCCr3–12 to CADI and to end-point transplant function were better than the correlations of the number of acute rejections (r = 0.876, P = 0.0001) and (r = 0.811, P = 0.0001), respectively, indicating that AUCCr3–12 is a more sensitive parameter than the number of acute rejections for predicting chronic rejection. Our results also indicate that there is a causal relationship between acute and chronic rejection, and that not only the frequency but also the intensity and length of acute rejections contribute. Reduction in the number of acute rejection episodes as well as minimizing their intensity with aggressive immunosuppressive therapy will both contribute to the reduction of chronic rejection.
- Subjects
CHRONIC kidney failure; KIDNEY diseases; TRANSPLANTATION of organs, tissues, etc.; CREATININE; KIDNEY transplantation; NEPHROLOGY; INTERNAL medicine
- Publication
Kidney International, 1995, Vol 48, Issue 1, p251
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1038/ki.1995.291