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| |  ASN: Earlier Major Rejections Experienced By Recipients Of Living Related Donor Grafts By Maggie Schwarz Special to DG News PHILADELPHIA, PA -- November 2, 2002 -- Living related donor graft recipients experience earlier and more acute rejection episodes than do cadaveric graft recipients, researcher say. The results of five-year study covering 2,136 renal transplant recipients from 90 centers throughout the United Kingdom was presented here at the 35th Annual Meeting of the American Society of Nephrology. Peter J. Dupont, MD, and colleagues from the Imperial College of Science, Technology and Medicine, London, England, were prompted to review UK transplantation data when they encountered a series of living related donor recipients who suffered severe acute rejection episodes in the early post-transplant phase. The patients studied were part of the larger LOTESS database of 6,574 renal transplant recipients who participated in a Novartis-funded study of cyclosporine microemulsion therapy. Baseline characteristics were recorded for all patients including age, sex, number of previous transplants, dialysis modality and duration on renal replacement therapy. Donor age/sex, graft ischemic time and donor-recipient HLA mismatch were also recorded. Participating centers submitted reports every three months detailing adverse events, with specific attention paid to episodes of graft dysfunction. All the patients started cyclosporine as base therapy following transplantation and were analyzed. A total of 1,919 received a cadaveric transplant and 217 a living donor transplant. Acute rejection rate in the first 12 months was significantly higher in the living donor group (35 versus 27 percent for cadaveric donors; p=.01). Rejection also occurred earlier in the living donor group (median time to first rejection, eight days for living donor versus 18 days for cadaveric donors; p=.0001). Comparing the two groups, living donor recipients were younger (mean age, 30 vs 43 years for cadaveric donor recipients; p=.01) and match grade was marginally less favourable (average DR mismatch for living donor graft recipients, 0.5, vs 0.7 for cadaveric donor graft recipients; p<.001). Ischemic times were considerably shorter for the living donor group (median for living donor, 1 hour, 24 minutes vs 19 hours, 46 minutes for cadaveric donors; p=.0001). Dr. Dupont concluded that in spite of shorter graft ischemic time, the risk of acute rejection is higher, and rejection episodes sooner, in recipients of living donor kidneys when compared with recipients of cadaveric grafts. He thought the poorer outcome of living related donor graft recipients might be attributed to their younger age and poorer match grade.
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