The Impact of Early Clinical and Subclinical T Cell Rejection After Kidney Transplantation.
Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA
Meeting: 2017 American Transplant Congress
Abstract number: D130
Keywords: Histology, Kidney transplantation, Rejection, Renal function
Session Information
Session Name: Poster Session D: Kidney: Acute Cellular Rejection
Session Type: Poster Session
Date: Tuesday, May 2, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Purpose: To evaluate the impact of early Clinical(C-TCMR) and Sub-Clinical(SC-TCMR) T Cell Mediated Rejection on short-term allograft histology and function.
Methods: We examined adult kidney alone recipients transplanted at our center from 1/1/13 to 11/1/14 with protocol biopsies at 3 and 12 months post-transplant(n=195). Serum creatinine (Cr) to 24 months and chronic histology score(ci + ct + cg+ cv) on the protocol biopsies were compared between Group I: No rejection on both biopsies, Group II: SC-TCMR, but no C-TCMR, and Group III: C-TCMR in the first post-transplant year. Patients received Thymoglobulin induction with Tacrolimus and MMF maintenance(Prednisone only if highly sensitized). Mild TCMR were treated with I.V steroids with Thymoglobulin for Banff ≥ 2A. Statistical analysis included Unpaired T test, Chi Square and ANOVA.
Results: Recipient and Donor characteristics(age, gender, race, donor source/age, CIT, DGF rate, HLA match, PRA) were similar except KDPI and presence of DSA within 1 year of transplant were higher in those with C-TCMR. Differences in Cr and histology are shown in Table 1.
| No Rejection (n=104) | SC-TCMR (n=56) | C-TCMR (n=35) | p value | |
| 3 month Cr(mg/dl) | 1.36 ± 0.44 | 1.58 ± 0.48 | 1.80 ± 0.78 | 0.0001 |
| 12 month Cr(mg/dl) | 1.33 ± 0.37 | 1.54± 0.53 | 1.97 ± 1.17 | <0.0001 |
| 24 month Cr(mg/dl) | 1.41 ± 0.44 | 1.57 ± 0.66 | 2.15 ± 1.60 | 0.0001 |
| 3 month Histology score | 1.31 ± 1.18 | 2.02 ± 1.42 | 2.33 ± 1.51 | 0.0001 |
| 12 month Histology score | 2.00 ± 1.13 | 2.92 ± 1.24 | 3.47 ± 1.49 | <0.0001 |
Furthermore, those with one(n=44) vs two(n=12) episodes of SC-TCMR had no significant difference in Cr or histology outcome. More than one (n=19) vs one (n=16) episode of C-TCMR resulted in higher 12 month histology score(p = 0.007) with similar renal function.
Conclusions: Kidney transplant recipients with early C-TCMR and SC-TCMR as opposed to those without rejection have:
i) Elevated creatinine through 24 months post-transplant
ii) Higher Chronic Allograft Histology scores at 3 months with further progression at 12 months
iii) C-TCMR has a greater impact on renal function and histology than SC-TCMR
iv) We anticipate worse long-term allograft function and survival in kidney transplant recipients with early C-TCMR and SC-TCMR.
CITATION INFORMATION: Hoffman W, Sood P, Mehta R, Cherukuri A, Wu C, Puttarajappa C, Shah N, Randhawa P, Tevar A, Hariharan S. The Impact of Early Clinical and Subclinical T Cell Rejection After Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Hoffman W, Sood P, Mehta R, Cherukuri A, Wu C, Puttarajappa C, Shah N, Randhawa P, Tevar A, Hariharan S. The Impact of Early Clinical and Subclinical T Cell Rejection After Kidney Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-early-clinical-and-subclinical-t-cell-rejection-after-kidney-transplantation/. Accessed November 25, 2024.« Back to 2017 American Transplant Congress