Chronic allograft failure in human renal transplantation: a multivariate risk factor analysis

Ann Surg. 2000 Jul;232(1):98-103. doi: 10.1097/00000658-200007000-00014.


Objective: To identify potential risk factors for the development of chronic renal allograft failure.

Summary background data: Chronic allograft failure (CAF) is the leading cause of late graft loss in renal transplantation. The authors studied the risk factors for the development of CAF in a single center during a period in which a consistent baseline immunosuppression regimen (cyclosporine, azathioprine, and prednisolone) was used.

Methods: Data from the Oxford Transplant Center Database were assessed on 862 renal allografts during a 10-year period. Risk factors were identified using multivariate logistic regression analysis.

Results: Biopsy-proven CAF occurred in 77 patients (9.2%) in the entire group. Multivariate risk factor analysis revealed that early and late acute rejection episodes, proteinuria, and serum triglycerides were significant factors. Acute rejection after 3 months was more important than early acute rejection. Serum triglyceride level and proteinuria at 1 year were both elevated in the CAF group. Male sex provided a protective effect. Serum creatinine levels at 6 months after the transplant were not predictive of the risk of developing CAF.

Conclusions: These results from the largest single-center review to date suggest that both antigen-dependent and -independent factors are involved in the pathogenesis of CAF. Acute rejection at all time points has a significant impact on the development of CAF.

MeSH terms

  • Adult
  • Chronic Disease
  • Creatinine / blood
  • Female
  • Graft Rejection*
  • Humans
  • Kidney Transplantation / immunology*
  • Logistic Models
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Triglycerides / blood


  • Triglycerides
  • Creatinine