Profiling risk for acute rejection in kidney transplantation: recipient age is a robust risk factor

Abbas Rana, Bhamidipati Murthy, Zachery Pallister, Michael Kueht, Ronald Cotton, N. Thao N. Galvan, Whiston Etheridge, Hau Liu, John Goss, Christine O’Mahony

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Careful management of immunosuppression is paramount to prevent acute rejection in kidney transplantation. We studied a cohort of 139,875 kidney transplant recipients from the Organ Procurement and Transplantation Network (OPTN) database between 2002 and 2013. We confirmed the analysis with a cohort of 35,277 who received thymoglobulin induction with tacrolimus maintenance, and a third cohort of 12,161 recipients who received basiliximab induction with tacrolimus maintenance. We performed multivariate logistic regression analyses on data from all three cohorts and identified independent risk factors for treated acute rejection at 1 year. Recipient age was a robust risk factor for rejection in all three cohorts in a dose response pattern. Young age (18–25 years) was among the strongest risk factors for rejection in all three cohorts; thymoglobulin cohort: OR 1.87 (1.59–2.19); basiliximab cohort: OR 2.41 (1.89–3.05); and inclusive cohort: OR 1.97 (1.83–2.12). The opposite was true for old age (65–69 years); thymoglobulin cohort: OR 0.69 (0.59–0.81); basiliximab cohort: OR 0.77 (0.62–0.96); and inclusive cohort: OR 0.75 (0.70–0.80). This study is unique because it is the largest and most comprehensive multivariate analysis that demonstrates recipient age is a robust risk factor for acute rejection in an inverse dose response pattern.

Original languageEnglish (US)
Pages (from-to)859-868
Number of pages10
JournalJournal of Nephrology
Issue number6
StatePublished - Dec 1 2017
Externally publishedYes


  • Acute rejection
  • Cellular rejection
  • Kidney transplantation
  • Recipient age

ASJC Scopus subject areas

  • Nephrology


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