The risk factors for graft loss in kidney transplant recipients (KTR) with non-adherence (NA) to immunosupression who present with rejection are not known.
We analyzed 208 NA KTR with biopsy (bx) proven acute rejection (AR) from 1984-2012. Proportional hazards regression was used to analyze time from bx to graft failure, adjusting for the following covariates: demographics, treatment of acute rejection (AR),serum creatinine (cr) at the bx, time from transplant to bx and severity of AR and chronic rejection (CR) (per Banff schema).
Results: Mean time from transplant to bx was 26.1 mos±38.7. Eighty four recipients (41%) did not receive any treatment for AR (group 1), while the remaining patients received either depleting antibody [n=27; 13.2% -group 2] or steroids alone [n=93; 45.6% -group 3]. Mean cr [mg/dl] was 5.0±5.8, 2.8±1.8 and 2.8±2.2 in groups 1,2 and 3 respectively. Mean AR grade was borderline, 1B and 1A in group 1,2 and 3 respectively (p<0.0001). There was no difference in chronicity grade between the groups.
In multivariate analysis, only higher cr at bx (by 1.0 mg/dl) and higher CR grade was associated with an increased risk of graft failure (Table1).
|Variable||Risk of Graft Failure|
|HR (95% CI)||pvalue|
|Age at Transplant (years)||1.01 (1.00, 1.02)||0.26|
|Female||1.44 (0.95, 2.19)||0.09|
|Black||1.41 (0.70, 2.84)||0.34|
|Other||1.64 (0.86, 3.14)||0.14|
|Time from Tx to Bx (months)||1.00 (0.99, 1.01)||0.85|
|Acute Rejection||1.04 (0.88, 1.24)||0.64|
|Chronic Rejection||1.52 (1.14, 2.03)||0.01|
|Creatinine at bx (increase by 1.0 mg/dl)||1.22 (1.14, 1.30)||0.01|
|Treatment for rejection:|
|Antibody||1.26 (0.68, 2.33)||0.46|
|Steroids||0.82 (0.53, 1.27)||0.38|
When graft outcomes were analyzed based on the Cr levels at the time of bx, adjusted for other covariates, risk for graft failure was the highest in recipients with creatinine >7 mg/dl (Table 2)
|Creatinine at bx [mg/dl]||Graft failure||p-value|
There was no difference in actuarial graft survival between treatment groups.
Conclusion: Higher Cr at biopsy and higher CR grade predicts graft loss in non-adherent KTRs. Treatment of AR may not prolong graft survival in NA patients, especially if advanced CR is present.
To cite this abstract in AMA style:Bista B, Jackson S, Issa N, Matas A, Kukla A. High Creatinine and Advanced Chronic Rejection (CR) Predicts Graft Loss in Non Adherent Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/high-creatinine-and-advanced-chronic-rejection-cr-predicts-graft-loss-in-non-adherent-kidney-transplant-recipients/. Accessed November 19, 2017.
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