Early Acute Rejection Episodes in Renal Transplantation in Relation to Immunosuppression Protocls: An Audit of 100 Cases M.P. Nair, M.R.N. Nampoory, T. Said, M.A. Halim, M. Mansour, K.V. Johny, M. Samhan, and M. Al-Mousawi ABSTRACT Introduction. Early acute rejection episodes (ARE) have deleterious effects on graft outcomes. The incidence of ARE in the first 3 months has been reported to be 20%. In a recent audit of ARE among 100 renal transplants, we observed the rates to be high (30%). We retrospectively collected details of donor type, induction therapy, immunosup- pression medications, drug levels, HLA mismatches, acute tubular necrosis (ATN), and delayed graft function (DGF) to correlate with ARE and response to therapy. Results. Thirty rejection episodes occurred after a mean period of 14.3 days after transplantation. Ninety-one patients had induction treatment with either antithymocyte globulin (ATG) or interleukin 2 receptor antibodies (IL2 Rab). The drugs included cyclosporine, mycophenolate, sirolimus, azathioprine, and prednisolone in these patients. There was no significant difference in ARE among the different drug protocols (30.7%– 35.2%). Subjects with 4 or more HLA mismatches displayed more ARE (40.3%) compared with those with 3 or less (23%). Subjects with ATN or DGF immediately posttransplantation had a higher incidence of ARE (39.2%) than those without them (26.3%). Deceased donor recipients had a higher episode of ARE (45.1%) compared with live related donor recipients (25%). On stratifying the known risk factors for ARE, subjects with no risk factors had the least (22.2%) ARE compared with those with one (32.5%) or two (47.6%) risk factors. Subjects who failed to achieve adequate cyclosporine (C2) levels showed significantly higher rates of ARE (86.9%) than those with adequate or higher levels (8.6%). Conclusion. Higher HLA mismatches, DGF, deceased donor, and failure to achieve adequate cyclosporine levels were observed to be major risk factors for the development of ARE. A CUTE REJECTION episodes (ARE) are the most frequent complications after renal transplantation with deleterious effects on graft survival. 1–4 ARE occurring in the first 3 months have been recently reported to be 20%. We recently conducted an audit of ARE in our unit because we noticed a 30% rate. PATIENTS AND METHODS One hundred consecutive renal transplantation over a period of 18 months underwent retrospective analysis to evaluate the incidence of ARE and its response to therapy. The diagnosis of ARE was usually biopsy-proven but sometimes based on clinical signs and a 30% creatinine level increase above baseline with a response to steroid pulse therapy. We correlated ARE rates with the donor type, induction immunosuppression therapy, maintenance medica- tions, drug levels, HLA mismatches, occurrence of acute tubular necrosis (ATN), and delayed graft function (DGF). RESULTS Among 100 renal transplantation over 18 months, 30 (30%) ARE were diagnosed, including 27 biopsy-proven and 3 based on clinical signs. The mean time to ARE was 14.3 From the Hamad Al Essa Organ Transplant Centre (M.P.N., M.R.N.N., M.A.H., M.M., M.S., M.A.-M.), and Department of Medicine, Faculty of Medicine (K.V.J.), Kuwait University, Safat, Kuwait. Address reprint requests to Dr M.P. Nair, c/o Professor K.V. Johny, Chairman, Department of Medicine, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait. E-mail: drprasadnair@hotmail.com © 2005 by Elsevier Inc. All rights reserved. 0041-1345/05/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2005.07.036 Transplantation Proceedings, 37, 3029 –3030 (2005) 3029