Journal of Clinical and Cellular Immunology
Open Access
ISSN: 2155-9899
ISSN: 2155-9899
Sailaja Kesiraju
Bhagwan Mahavir Medical Research Centre, India
Posters-Accepted Abstracts: J Clin Cell Immunol
Despite improvement in the short term graft survival due to progress in controlling acute rejections, improvement in the immunosuppression, chronic rejection remains a considerable hindrance, preventing the goal of long term graft survival. Chronic allograft dysfunction (CAD) or chronic allograft nephropathy (CAN) is the major cause of long-term graft loss in kidney transplant recipients.CAD is defined as functional and morphologic deterioration of a renal allograft. CAD is characterized clinically by progressive deterioration in renal function combined with proteinuria, hyper tension and renal insufficiency with nonspecific pathology in renal transplant recipients. Chronic allograft dysfunction is the most prevalent cause of late renal allograft loss. A complex network of cellular mechanisms in both graft and peripheral immune compartments complicates the noninvasive diagnosis of CAN, thereby requiring biopsy histology. This is compounded by non-immunological factors contributing to graft injury. Immunological factors include: Chronic active rejection, chronic rejection of both cellular and humoral, while non immunological include CNI toxicity, recurrence of glomerular disease, infections etc. Chronic rejection is not reversible and has been recognized as the most important cause of the graft dysfunction. Chronic rejection is a complex pathophysiological response involving many components of the immune system as well as non-immune factors. T cells, macrophages, chemokines, pro-inflammatory cytokines and alloantibodies have all been implicated in both the initiation and progression of the rejection process. We aimed to assess the prevalence and correlation factors of graft dysfunction, and its effects on long-term graft survival. Renal transplant recipients transplanted between March 2000 and April 2014 were included. Clinical parameters, etiology of ESRD, number of dialysis, surgical complications, history of acute rejections, creeping serum creatinine, immuno-suppression regimen, glomerular filtration rate, and patient and graft survivals were analyzed. CAD and death with functioning graft were the major causes of the graft loss in this cohort. Recurrence of the glomerular disease was the third major cause of graft loss. Acute tubular necrosis was the most common cause for renal graft dysfunction. High dose of CNIs in the early stage might affect the recovery of the early renal function. The early renal dysfunction, donor age and AR episodes would affect the renal graft long-term survival.
Email: kesirajusailaja@gmail.com