A Prospective Study of Renal Function and Histological Changes in Renal Transplant Recipients With Acute Clinical and Subclinical Rejection
1Nephrology, University of Pittsburgh Medical Center, Pittsburgh, PA
2Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
3Transplant Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Meeting: 2015 American Transplant Congress
Abstract number: D164
Keywords: Histology, Rejection, Renal function
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
Background: To study the impact on renal function and histological changes in patients(pts) with acute clinical rejection(ACR) and subclinical rejection(SCR) from 3 to 12 month(m) post-transplant.
Methods: We prospectively followed pts(n=138) for 1 year who had kidney transplant at our center from Jan to Sept 2013. Protocol biopsies were performed at 3 and 12m post-transplant(n=60). The pts were divided into 4 groups(gp) based on 3m protocol biopsies: those with SCR(gp1), without rejection(gp2), with ACR(gp3) and without biopsy(gp4). All rejection pts(n=31) were treated per our center's protocol. Serum creatinine and eGFR were measured at 3, 6 and 12m. Acute and chronic composite scores were calculated for the 3-and-12m biopsies. Data was analyzed using repeat measures ANOVA, T-test and chi-square.
Results: There were no significant differences in baseline demographics and other variables. Renal function was worse at 3 and 6 m post-transplant in pts with ACR but was not different within the pts in each gp. Acute composite scores improved, without statistical significance, from 3 to 12 m in pts with ACR and SCR. There was no significant change in mean chronic composite scores from 3 to 12m in those pts.
| Demographics | Gp1(n=15) | Gp2(n=64) | Gp3(n=16) | Gp4(n=43) | p | ||
| Age(mean,range,years) | 52.9(23-81) | 50(24-80) | 49.5(22-78) | 54.5(23-83) | |||
| Gender(M/F) | 10/5 | 40/24 | 6/10 | 23/20 | 0.25 | ||
| Race(W/AA/Other) | 14/1/0 | 40/15/1 | 11/5/0 | 39/4/0 | 0.24 | ||
| KDPI% | 41(7-81) | 39.6(2-89) | 45(8-79) | 44(2-88) | 0.91 | ||
| Donor(Deceased/Living) | 11/4 | 31/33 | 9/7 | 31/12 | 0.06 | ||
| Organ(DBD/DCD/Living) | 8/3/4 | 25/6/33 | 8/1/7 | 26/5/12 | 0.34 | ||
| Serum Creatinine(mg/dl) | |||||||
| 3m | 1.46 | 1.42 | 1.73 | 1.34 | 0.04 | ||
| 6m | 1.49 | 1.50 | 1.65 | 1.23 | 0.02 | ||
| 12m | 1.53 | 1.54 | 1.76 | 1.33 | 0.1 | ||
| p | 0.27 | 0.05 | 0.69 | 0.9 | |||
| eGFR(ml/min) | |||||||
| 3m | 58 | 58 | 44 | 59 | |||
| 6m | 52 | 58 | 45 | 63 | |||
| 12m | 51 | 56 | 42 | 59 | |||
| p | 0.13 | 0.34 | 0.67 | 0.97 | |||
| Mean Acute Composite Score(i+t+v+g+PTC+c4d) | |||||||
| 3m | 5.7(n=12) | 0.95(n=40) | 4(n=8) | ||||
| 12m | 3.5(n=12) | 2.6(n=40) | 2.93(n=8) | ||||
| p | 0.07 | 0.0005 | 0.37 | ||||
| Mean Chronic Composite Score(ct+cv+ci+cg) | |||||||
| 3m | 2.58(n=12) | 1.42(n=40) | 2.18(n=8) | ||||
| 12m | 3.41(n=12) | 2.32(n=40) | 2.25(n=8) | ||||
| p | 0.16 | 0.0014 | 0.91 | ||||
Conclusion: Diagnosis and treatment of ACR and SCR resulted in stabilization of renal function and prevented progression towards chronicity per renal histological score from 3 to 12m post-transplant.
To cite this abstract in AMA style:
Chen S, Mehta R, Sood P, Randhawa P, Shah N, Wu C, Tevar A, Hariharan S. A Prospective Study of Renal Function and Histological Changes in Renal Transplant Recipients With Acute Clinical and Subclinical Rejection [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/a-prospective-study-of-renal-function-and-histological-changes-in-renal-transplant-recipients-with-acute-clinical-and-subclinical-rejection/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress