Comparative study between different immunosuppressive treatment regimens and acute rejection in renal transplant recipients in Nasr City Insurance Hospital

Abstract

Renal transplantation is the best treatment for most patients with end-stage renal disease and is associated with significant improvements in quality of life and survival of patients with successful kidney grafts. Acute renal allograft rejection is a major cause of allograft dysfunction, though it is much less common since the advent of more potent immunosuppressive agents. In our retrospective cohort study which was donein single transplantation center in Nasr City Health Insurance Hospital, Egyptwhich included 74 patientswhom received kidney transplantation in the period from 2000 to 2005 in Nasr City Health Insurance Hospital and followed up in Nasr City Health Insurance Hospitaltill 2013, we found the all patients were living donor recipients(67.6%) of the patientsreceived kidneys From Unrelated donorand (32.4%) of the patients were donor related. The prevalence of acute renal allograft rejection in our study was (21.6%)among the study population and we reported thehistory of previous renal transplantation (2.7%), while the most of patients (91.9%) were on dialysis pre-operative, most of the patients (70.3%) of them received multiple blood transfusion,(14.9%)of them had history of multiple pregnancies,(18.9%)

of them had history of HCV infection before transplantation, and we found the delayed graft function in the studied population was present in 3case (4.2%) and it was due to obstruction in urinary and not present in 73cases (95.8%) and we foundthe prevalence of cyclosporine toxicity in the study population is (5.4%), theprevalence of Interstitial fibrosis and tubular atrophy (IFTA) was (12.1%), the prevalence ofBorderline changes was (6.8%) in the studied population and (59.5%) of them didn’t have rejection. We compared between patients with acute rejection and patients without and we found no significant difference was found between patients with acute rejection and patients without except in history of Multiple Blood transfusion before renal transplantation p-value (0.02). We found that the Twelve years graft survival is (93.2%), prevalence of graft loss of (6.8%) in the study. Limitations of our study were the low number of patients (74) and most of them were on the same drug regimen Steroid/Sandimun/ Imuran in this timedue to cost. Conclusion:The incidence of acute graft rejection is decreased in last decades but still high among our patients in this time and there was no effect of different immunosuppressive drug regimens in this time on occurrence of acute rejection and graft survivalamong our patients.