Aim: to gather clinicians' views and practice patterns on the diagnosis, treatment and monitoring of acute T-cell mediated rejection (TCMR) in Canada.

Methods: As part of the Canadian National Research Transplant Program, a web-based survey on the diagnosis and treatment of TCMR was developed. The survey was disseminated on 3 occasions between June and October 2016 through the Canadian Society of Transplantation kidney group electronic mailing list.

Results: Forty seven respondents from at least 18 of the 25 Canadian centers offering kidney transplantation participated in the study. The use of surveillance biopsies was reported by 28% of respondents (95% confidence interval (CI): 15-41). To treat clinical rejection of borderline grade by Banff class, 33% (95%CI: 19-45) used high-dose intravenous or oral steroids alone, 46% (95%CI: 31-61) used high-dose steroids in addition to optimized exposure to maintenance immunosuppressants (IS) and 17% (95%CI: 7-28) optimized exposure to maintenance IS without high-dose steroids. To treat clinical Banff grade IA rejections, 33% (95%CI 19-45) used high dose steroids alone, while others would also optimize exposure to maintenance IS. To treat clinical Banff grade 1B, 91% (95% 83-99) of respondents used high dose steroids and increased exposure to maintenance IS while 9% (95%CI 1-17) used lymphocyte depleting agents additionally as a first-line approach. Respondents indicated that they would not treat sub-clinical rejections of borderline severity in 9% (95%CI: 0-26), while 27% (95%CI: 1-53) would only increase exposure to maintenance IS, 9% (95%CI: 0-26) would use high-dose steroids alone and 55% (95%CI: 26-84) would use a combination of high-dose steroids and increased exposure to IS. Sub-clinical Banff grade 1A and 1B were both treated with high dose steroids in 91% (95%CI: 74-100), while 9% (95%CI:0-26) only increased exposure to maintenance IS.

Conclusion: There is significant heterogeneity in practice patterns for the treatment of TCMR in Canada amongst transplant physicians. Harmonization would facilitate the design of future studies aimed at exploring novel therapies for TCMR.

CITATION INFORMATION: Leblanc J, Subrt P, Paré M, Hartell D, Sénécal L, Blydt-Hansen T, Cardinal H. Practice Patterns in the Treatment and Monitoring of Acute Cell-Mediated Kidney Graft Rejection in Canada. Am J Transplant. 2017;17 (suppl 3).

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