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Abstract This study was conducted at National Institute Of Urology & Nephrology aiming to study the impact of early and late acute rejection on graft survival after renal transplantation. We included a total of 120 cases with renal transplant, who were divided into 3 groups; group I included 100 cases who did not experience rejection, group II included 11 cases who developed early acute rejection, and group III included 9 cases who developed late acute rejection. There was no significant difference between the three groups regarding age (29.8, 31.64, and 29.33 years respectively – p = 0.375). Although the age was younger in late acute rejection group, it was not significantly different between the study groups. Furthermore, there was no significant difference between donor age in the three study groups (p = 0.838). There was no significant difference between the three groups regarding either recipient or donor gender (p = 0.932 and 0.567 respectively). Besides, there was no significant difference between the three groups regarding donor-recipient relationship (p = 0.523). Either having related or unrelated donor did not have an impact on acute rejection in the current study. The etiology of CKD or ESRD did not differ significantly between the current study groups (p > 0.05). This may point to that the initial cause of renal failure did not have an impact on development of acute rejection in the current study. Likewise, the duration of dialysis did not constitute a significant difference between the three study groups (p = 0.680). 73 Summary The duration of renal transplantation was not significantly different between the three groups (p = 0.317). Although basal serum creatinine did not differ between the three groups in the current study (p = 0.24), the last follow up serum creatinine was significantly higher in both early and late acute rejection groups (p < 0.001). Poor drug compliance was more significantly encountered in the early rejection group (27.3%), while it was not reported in the late rejection. The non-rejection group reported non-compliance in 2% of its cases (p = 0.009). HLA mismatch was also statistically significant between the three study groups (p = 0.027). It was present in 11.1% and 9.1% of cases in LAR and EAR groups respectively. Nevertheless, it was absent in the nonrejection group. On the other hand, old donor age was significantly more prevalent in the early rejection group (p = 0.013). CMV infection had significantly higher prevalence in the rejection groups (18.2 and 22.2% respectively), while it was present in only 2% in the non-rejection group (p = 0.007). The current results showed that there was significant difference between the three study groups regarding the GFR at the end of the study duration (p < 0.05). GFR was markedly decreased in both early and late rejection groups (19.73 and 20.33) compared to non-rejection group (GFR = 73.08). The incidence of ESKD was significantly higher in the rejection groups compared to the first group (p = 0.012). Therefore, it is evident that acute rejection has a negative impact on graft survival. Nevertheless, the incidence of CKD was higher in the group I (67%) compared to the rejection groups (63.6 and 66.7% respectively). Mortality did not constitute |