Impact of Subclinical Rejection (SCR) and Acute Clinical (ACR) in Renal Transplant Recipients
University of Pittsburgh Medical Center, Pittsburgh, PA.
Meeting: 2015 American Transplant Congress
Abstract number: D158
Keywords: Kidney transplantation, Protocol biopsy, Rejection
Session Information
Session Name: Poster Session D: Kidney: Acute Rejection
Session Type: Poster Session
Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
The importance of diagnosing subclinical rejection and its short and long term impact remains controversial.
We prospectively evaluated 296 patients who had a kidney transplant at our institute between January 2013 – June 2014. After excluding eight patients, the remaining 288 patients were divided into 4 groups on the basis of their 3 month protocol biopsy. Group 1 : patients with SCR; Group 2 : patients with normal biopsies; Group 3 : patients with ACR on for cause biopsy and Group 4 were patients who did not undergo protocol biopsy. All patients received induction therapy with thymoglobulin(94%), simulect(5%) or alemtuzumab(1%). Maintenance therapy included tacrolimus and MMF and rapid steroid withdrawal by day 7. Banff classification was followed for biopsy grading and patients were treated per our center protocol. Recipient demographics and post transplant renal functions are shown in table 1. The t-test, ANOVA or chi square test were used as indicated for statistical analysis.
| Grp 1(n=37) | Grp 2(n=132) | Grp 3(n=33) | Grp 4(n=86) | p value | |
| 37/202=18.3% | 132/202=65% | 33/288=11.4% | 86/288=30% | ||
| Age(yrs) | 53 | 51 | 48 | 55 | NS |
| M/F(%) | 70/30 | 63/27 | 33/67 | 55/45 | 0.007 |
| Race (W/O)(%) | 76/24 | 78/22 | 76/24 | 83/17 | NS |
| LD/DD(%) | 27/73 | 46/54 | 42/58 | 33/67 | 0.02 |
| HLA DR(mean) | 1.3 | 1.2 | 1.4 | 1.3 | NS |
| HLA total(mean) | 4.2 | 3.9 | 4.2 | 4 | NS |
| PRA% (I/II)(mean) | 4.8/8.4 | 6.5/15.5 | 8/7.1 | 13/12 | NS |
| DSA(Y/N)(%) | 30/70 | 17/83 | 33/67 | 14/86 | 0.03 |
| CIT(min)(mean) | 499 | 382 | 394 | 502 | NS |
| DGF(Y/N)(%) | 38/62 | 8/92 | 18/82 | 20/80 | 0.0002 |
| Bord/Banff IA or greater(%) | 25/75 | NA | 24/74 | NA | |
| SCr 3m (mean) | 1.62±0.09 | 1.43±0.05 | 1.70±0.08 | 1.32±0.08 | 0.03 |
| SCr 6m (mean) | 1.52±0.09 | 1.48±0.05 | 1.58±0.06 | 1.24±0.04 | 0.0018 |
| SCr 1 yr (mean) | 1.64±0.13 | 1.52±0.07 | 1.73±0.13 | 1.34±0.09 | NS |
| Change in Cr 3-6m | -0.34* | -0.05* | -0.22 | -0.16 | 0.04 |
Results
1. Incidence of SCR and ACR at 3 months was 18% and 11% respectively
2. Post transplant serum creatinine was higher in patients with SCR and ACR at 3,6 and 12 months
3. Renal function improved in patients with SCR from 3 to 6 months
4. DD transplant, presence of DSA and DGF were associated with a higher incidence of SCR
Conclusions
1. SCR was diagnosed in 18% of renal transplant recipients at 3 months
2. Serum creatinine was significantly elevated at 3 and 6 months in patients with SCR and ACR
3. Detection of SCR at 3 months and appropriate treatment improved renal function
To cite this abstract in AMA style:
Mehta R, Sood P, Cherukuri A, Chen S, Mour G, Wu C, Shah N, Puttarajappa C, Randhawa P, Tevar A, Hariharan S. Impact of Subclinical Rejection (SCR) and Acute Clinical (ACR) in Renal Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-subclinical-rejection-scr-and-acute-clinical-acr-in-renal-transplant-recipients/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress