Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/121468
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dc.contributor.authorClayton, P.en
dc.contributor.authorMcdonald, S.en
dc.contributor.authorRuss, G.en
dc.contributor.authorChadban, S.en
dc.date.issued2013en
dc.identifier.citationJournal of the American Society of Nephrology, 2013; 18(9):43en
dc.identifier.issn1046-6673en
dc.identifier.issn1533-3450en
dc.identifier.urihttp://hdl.handle.net/2440/121468-
dc.description.abstractBackground: Declining rates of acute rejection (AR) and the high rate of 1-year graft survival among patients with AR have prompted re-examination of AR as an outcome in the clinic and in trials. Yet AR and its treatment may directly or indirectly affect longer-term outcomes for kidney transplant recipients. Methods: To understand the long-term effect of AR on outcomes, we analyzed data from the Australia and New Zealand Dialysis and Transplant Registry, including 13,614 recipients of a primary kidney-only transplant between 1997 and 2017 with at least 6 months of graft function. The associations between AR within 6 months post-transplant and subsequent cause-specific graft loss and death were determined using Cox models adjusted for baseline donor, recipient, and transplant characteristics. Results: AR occurred in 2906 recipients (21.4%) and was associated with graft loss attributed to chronic allograft nephropathy (hazard ratio [HR], 1.39; 95% confidence interval [95% CI], 1.23 to 1.56) and recurrent AR beyond month 6 (HR, 1.85; 95% CI, 1.39 to 2.46). Early AR was also associated with death with a functioning graft (HR, 1.22; 95% CI, 1.08 to 1.36), and with death due to cardiovascular disease (HR, 1.30; 95% CI, 1.11 to 1.53) and cancer (HR, 1.35; 95% CI, 1.12 to 1.64). Sensitivity analyses restricted to subgroups with either biopsy-proven, antibody-mediated, or vascular rejection, or stratified by treatment response produced similar results. Conclusions: AR is associated with increased risks of longer-term graft failure and death, particularly death from cardiovascular disease and cancer. The results suggest AR remains an important short-term outcome to monitor in kidney transplantation and clinical trials.en
dc.description.statementofresponsibilityPhilip A. Clayton, Stephen P. McDonald, Graeme R. Russ and Steven J. Chadbanen
dc.language.isoenen
dc.publisherAmerican Society of Nephrologyen
dc.rights© 2019 by the American Society of Nephrologyen
dc.subjectKidney transplantation; rejection; chronic allograft failure; survivalen
dc.titleLong-term outcomes following acute rejection in kidney transplant recipients: an ANZDATA analysisen
dc.typeJournal articleen
dc.identifier.rmid0030120735en
dc.identifier.doi10.1681/asn.2018111101en
dc.identifier.pubid480848-
pubs.library.collectionMedicine publicationsen
pubs.library.teamDS14en
pubs.verification-statusVerifieden
pubs.publication-statusPublisheden
dc.identifier.orcidClayton, P. [0000-0001-9190-6753]en
dc.identifier.orcidMcdonald, S. [0000-0001-6103-1386]en
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