Audit of acute rejection in renal allografts
Date
2020
Authors
Thomas, Riju Mathew
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Abstract
Acute graft rejection is acknowledged to have a negative impact on graft survival in renal
transplantation. South Africa provides for limited renal transplantation amidst the increasing
burden of chronic kidney disease in the local context. Despite this suboptimal provision and
limited resources, amongst many other concerns, the role of acute graft rejection on graft
survival has not been characterized in the context of South Africa, as well as the African
continent. This study is an audit, characterising acute graft rejection diagnosed at the
Charlotte Maxeke Johannesburg Academic Hospital over a ten-year period (2003-2012).
The study revealed the incidence of acute rejection in renal transplants to be 34.5%, similar
to that reported in international studies. The majority of acute rejections occurred within the
first year of transplantation (53.8%), which was lower than that reported in other studies, with
40% of patients having recurrence of acute rejection. The main form of rejection diagnosed
was acute cellular rejection (predominantly BANFF grades 1A and 1B), followed by Borderline
acute cellular rejection, the combination of which comprised the majority (86.9%) of all
rejections diagnosed.
This population was found to be a male dominant and Black African dominant study group, in
keeping with the racial distribution of the dialysis population of South Africa, commonly
influenced by treatment-seeking behaviour. Cadaveric donor grafts were engrafted in 77.7%
of this population and 77.8% of the population had less than 40% of HLA antigens in common
with their donor. Delayed graft function was observed in 22.4% of recipients with a significant
association with more severe acute graft rejection. Hypertension was the most dominant
primary aetiology leading to chronic kidney disease of native kidneys in this population.
Immunosuppressive regimen, including cyclosporin, mycophenolate mofetil and prednisone,
was used in 80% of recipients, with 97.6% of recipients on mycophenolate mofetil and
prednisone.
The five-year survival of grafts developing acute rejection was 61.7%. Graft function
deteriorated more dramatically amongst recipients who progressed to graft loss, with
recovery of graft function observed to be more prominent amongst recipients with surviving
grafts.
This study adds to the literature on this topic, and also describes the characteristics and
outcomes of this entity.
Description
A research report submitted in partial fulfilment of
the requirements for the degree of Master of Medicine to the Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, 2019