Rejection episodes and patient and graft survival after renal transplantation.

The occurrence of acute rejection episodes following renal transplantation was correlated with one-year patient mortality and graft failure rates in a series of 102 consecutive transplant recipients. Twenty-one patients had two or more rejection episodes in the first two months post transplantation; 17 of these expired or lost their kidney compared to only 5 of 28 patients with no rejection episodes in this time period. Similarly, of the 14 patients who developed a second rejection episode 2--6 months post transplantation, 8 died or lost the graft compared to only 2 of 21 patients who had no rejection episodes in this time period. Thus, the development of a second rejection episode early after transplantation necessitating treatment with high dose prednisone therapy carries an ominous prognosis and suggests that serious consideration must be given to graft removal and subsequent retransplantation.