The effect of acute rejection on long‐term renal graft survival is mainly related to initial renal damage

It has been suggested that poor long-term prognosis of acute rejection is due to hyperfiltration-mediated injury secondary to the initial renal damage, rather than to ongoing immunological mechanisms. A total of 953 renal transplant recipients was reviewed to examine the effect of acute rejection episodes on graft function and survival; 40 % had no rejections, 45 % one, 12 % two and 3 % three. Rejection episodes adversely affected short- and long-term prognosis (5-year survival for no rejections, 62 %; one, 34 %; two, 26 %; three, 19 %, P 60 ml/min (5-year graft survival none and one, 87 %; two and three, 71 %, P 2 months after transplantation) initial rejection is an important independent risk factor for graft loss.