LONG-TERM RENAL ALLOGRAFT SURVIVAL

Abstract

We conclude that late occurrence of a first acute rejection portends a worse prognosis for allograft survival after the first year. Later rejections, in combination with previous rejections, also lead to worse long-term allograft survival. Unlike early ATRs occurring in the setting of supervised immunosuppression, late occurring ATR may reflect inadequate immunosuppression from noncompliant behavior or may reflect disruption or lack of immune tolerance to the allograft. Efforts to minimize late transplant loss require a combination of strategies directed at both immunologic and behavioral factors.