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The number, timing, type (<jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>\u2010cell\u2010mediated or antibody mediated), and severity of biopsy\u2010proven acute rejection (<jats:styled-content style=\"fixed-case\">BPAR<\/jats:styled-content>) episodes in terms of histological changes and functional impact are highly influential for graft prognosis, and a crude measure of overall acute rejection incidence alone is unlikely to be a robust predictor of graft outcome. A series of studies has shown remarkably consistent results in terms of the cutoff point for one\u2010yr renal function which predicts poor long\u2010term graft survival, indicating that a threshold of 50\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup> is likely to be appropriate. Estimated glomerular filtration rate at one\u00a0yr post\u2010transplant discriminates effectively among immunosuppressive regimens with regard to graft survival, primarily calcineurin inhibitor reduction strategies. Several other factors that can affect graft survival, such as pathological changes in the graft, may be partly influenced by the immunosuppressive regimen, but the contribution of drug therapy is difficult to define. A combined approach in which both treated <jats:styled-content style=\"fixed-case\">BPAR<\/jats:styled-content> and renal function at one\u00a0yr are used to assess novel immunosuppressive regimens appears to be promising as the emphasis shifts toward sustaining kidney allograft survival over the long term.<\/jats:p>","DOI":"10.1111\/ctr.12554","type":"journal-article","created":{"date-parts":[[2015,4,20]],"date-time":"2015-04-20T13:01:35Z","timestamp":1429534895000},"page":"644-653","source":"Crossref","is-referenced-by-count":10,"title":["Identifying endpoints to predict the influence of immunosuppression on long\u2010term kidney graft survival"],"prefix":"10.1111","volume":"29","author":[{"given":"Titte R.","family":"Srinivas","sequence":"first","affiliation":[{"name":"Kidney and Pancreas Transplant Programs Division of Nephrology Medical University of South Carolina Mount Pleasant SC USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Oppenheimer","sequence":"additional","affiliation":[{"name":"Renal Transplant Unit Hospital Cl\u00ednic de Barcelona Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,18]]},"reference":[{"key":"e_1_2_7_2_1","article-title":"Evolution of graft survival in kidney transplantation: an analysis of the OPTN\/UNOS Renal Transplant Registry","volume":"1","author":"Amico P","year":"2010","journal-title":"Clin Transpl"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03283.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2009.06.049"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12019"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03104.x"},{"key":"e_1_2_7_7_1","unstructured":"U.S. Food and Drug Administration.Endpoints for Clinical Trials in Kidney Transplantation; Public Workshop.http:\/\/www.fda.gov\/Drugs\/NewsEvents\/ucm305308.htmAccessed 1 December 2014."},{"key":"e_1_2_7_8_1","unstructured":"European Medicines Agency.Guideline on clinical investigation of immunosuppressants for solid organ transplantation.http:\/\/www.ema.europa.eu\/docs\/en_GB\/document_library\/Scientific_guideline\/2009\/09\/WC500003593.pdf(Accessed 1 December 2014)."},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2011.12.014"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.01198.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000255583.34329.dd"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03640.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2010.06.027"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.04681107"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2003.00104.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.2002.00424.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2010.10.054"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/08860220801947686"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2009.01186.x"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1159\/000182816"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04304.x"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.01230.x"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03240.x"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2010010049"},{"key":"e_1_2_7_25_1","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1681\/ASN.V1271538","article-title":"Increased immunogenicity and cause of graft loss of old donor kidneys","volume":"12","author":"Fijter J","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181f65c7d"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-012-2330-6"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1432-2277.2009.00878.x"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12852"},{"key":"e_1_2_7_30_1","unstructured":"United States Renal Data System (USRDS) Annual Report2012. 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