Risk Factors for Acute Rejection After Deceased Donor Kidney Transplantation in China

Objectives: This study aimed to identify the potential risk factors of acute rejection after deceased donor kidney transplantation in China. Methods: Adult kidney transplantations from deceased donors in our center from February 2004 to December 2015 were enrolled for retrospective analysis. All deceased donations complied with China's Organ Donation Program. No organs from executed prisoners were used. The incidence of clinical and biopsy-proved acute rejection was assessed with the Kaplan-Meier method, and the Cox proportional hazard model was used for multivariate analysis. Results: One-year, 2-year, 3-year and 5-year incidences of acute rejection were 12.4%, 14.2%, 14.8%, and 17.1%, respectively. Multivariate analysis demonstrated that longer pre-transplant dialysis duration (hazard ratio [HR] 1.009 per month; 95% confidence interval, 1.003–1.015; P =.003), positive pre-transplant panel reactive antibody (PRA) (positive vs negative HR 3.266; 1.570–6.793; P =.023), and increasing HLA mismatches (≥4 vs < 4 HR 2.136; 1.022–4.465; P =.044) increased the risk of acute rejection, while tacrolimus decreased acute rejection risk compared to cyclosporine (HR 0.317; 0.111–0.906; P =.032). Conclusion: Longer pre-transplant dialysis duration, HLA mismatch, and positive pre-transplant PRA increase the risk of acute rejection, while tacrolimus helps prevent acute rejection compared to cyclosporine in deceased donor kidney transplantation.