Impact of Early Borderline Histological Changes on Subsequent Events in Renal Transplant Recipients
University of Pittsburgh Medical Center, Pittsburgh, PA
Meeting: 2019 American Transplant Congress
Abstract number: 430
Session Information
Session Name: Concurrent Session: Kidney: Acute Cellular Rejection
Session Type: Concurrent Session
Date: Tuesday, June 4, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: Ballroom C
*Purpose: The significance of borderline changes suspicious for rejection noted on early renal allograft biopsies on subsequent events in renal transplant recipients is unclear.
*Methods: Between Jan 2013 and Dec 2016, a total of 802 patients underwent a kidney transplant at our institute (LD and DD). Graft losses within the first year, inadequate biopsies, biopsies meeting criteria for T Cell Mediated Rejection, Antibody Mediated Rejection, BK nephritis, recurrent disease within the first 3 months post transplantation were excluded.The remaining 336 patients, on the basis of their 3 month biopsy were divided into Borderline Inflammation (BI)(n=187) with t score >0 with or without concomitant i score >0, but not meeting criteria for Banff IA rejection or higher; and No inflammation (NI)(n=149) with i0t0 scores.The induction regimen comprised of thymoglobulin and maintenance regimen comprised of tacrolimus and MMF.
*Results: Donor and recipient demographics, including age, sex, race, PRA, HLA mm, tacrolimus levels, DGF and cold ischemia time in the 2 groups were similar. 1. Subsequent TCMR, both clinical and subclinical till 1 year were noted to be higher in BI compared to NI (23% vs 11.5%; p<0.01) 2. IFTA scores (ct+ci >2) at 1 year biopsy were also higher in BI (23% vs 7%; p<0.01). 3. De novo DSA was higher in BI (9 vs 1; p=0.03) 4. Renal function was worse at 1 yr and 2 yrs in BI "$$table"
*Conclusions: Borderline changes noted in early transplant allograft biopsies have a negative impact on: 1. Renal function up to 2 years 2. Allograft chronicity (IFTA) 3. development of de novo DSA during the first 2 years post transplant and 4. Subsequent rejections (Clinical and Subclinical TCMR) during the first year post transplant.
Grp | BI | NI | p value |
Cr 3m (SD) | 1.57(0.6) | 1.45(0.5) | 0.11 |
Cr 1y (SD) | 1.62(0.8) | 1.38(0.5) | 0.004 |
Cr 2y (SD) | 1.67(0.8) | 1.43(0.6) | 0.011 |
To cite this abstract in AMA style:
Mehta R, Tandukar S, Jorgensen D, Owoyemi I, Shah N, Puttarajappa C, Wu C, Hariharan S. Impact of Early Borderline Histological Changes on Subsequent Events in Renal Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-early-borderline-histological-changes-on-subsequent-events-in-renal-transplant-recipients/. Accessed September 7, 2024.« Back to 2019 American Transplant Congress