Characterisation of rejection episodes in an incident population of kidney transplant recipients

Kidney transplantation (Tx) is the therapy of choice for end-stage renal disease. It has been proven that the survival within transplanted patients, compared with dialysis patients, is greater. However, it is known that several factors can influence the graft outcome. One of them is the acute rejection, resulting from the innate and adaptive immune responses to foreign donor antigens. However, no study has been conducted to identify what are this factors in our centre yet. In this study, we aim to update the database of the Lausanne/CHUV kidney transplant recipients cohort in order to characterize this population. We intend to identify the determinants associated with graft rejection and graft outcome at 1-year post transplantation. Clinical data are provided from the CHUV prospective databases from the day of Tx to one year post Tx. We first performed a general analysis of all confounding factors that we considered relevant based on recipients’ graft function at one year after Tx. We studied then associations between immunological and clinical factor with acute graft rejection. We finally compared acute cellular rejection (ACR) to acute antibody mediated rejection (AMR). After one year, the rate of acute rejection was 15.9% (47.5% ACR and 25% AMR). Main found predictors tended to be related rather with acute AMR and reflected presensitization (prior transplantation, positive last PRA values and pre-existing DSA). Acute rejection was associated with decreased renal function (by around 14 ml/min of GFR in the first year)