Introduction: To establish risk stratifying criteria for acute rejection (AR) after kidney transplantation (KT) through analyzing the preoperative risk factors of KT recipients from deceased donor (DD).
Method: The data of kidney transplant recipients who received deceased donor-derived kidneys in the renal transplantation department of the First Affiliated Hospital of Xi'an Jiaotong University between January 2015 and December 2020 were retrospectively analyzed with a follow-up period of >1 year, and a total of 1,382 recipients were included and divided into an acute rejection group (AR group, 115 cases) and a non-acute rejection group (non-AR group, 1,267 cases). A statistical algorithm was applied to determine the risk factors for AR and their regression coefficients by univariate and multifactorial analysis of the clinical data of the two groups, then establish the scoring criteria based on the result. The recipients were divided into low, risk and high risk groups according to their scores, and the occurrence of AR in the different scoring groups was analyzed and compared.
Result：Acute rejection occurred in 115 of 1 382 recipients within 1 year after surgery, with an
overall AR incidence of 8.32% (115/1,382). After univariate analysis, variables that were statistically different (P<0.05) were included in further multivariate logistic regression analysis calculations, and those that were statistically significant were finally identified. Scores were calculated based on their regression coefficients, and a recipient scoring system with a total score of 36 was established. The recipients were divided into low, intermediate, and high-risk groups according to the tertile of the score, and the incidence of AR in the three groups was 4.3%, 14.7%, and 40.0%, respectively, with a significantly higher incidence of AR in the intermediate and high-risk groups than in the low-risk group (all P<0.001).
Conclusion：The immune risk assessment criteria for kidney transplant recipients from DD sources can effectively differentiate the risk of postoperative AR in kidney transplant recipients; For recipients with middle/high immune risk, intensity and dose of immunosuppressants should  be  appropriately  boosted  during  preoperative  induction  and  maintenance  period.  And  the occurrences of AR and infection should be dynamically monitored.