Outcomes of Phenotypes in Early Subclinical Inflammation (SCI) Determined by Presence of Interstitial Inflammation with or without Concomitant Tubulitis
University of Pittsburgh Medical Center, Pittsburgh, PA
Meeting: 2019 American Transplant Congress
Abstract number: C161
Keywords: Inflammation, Kidney transplantation, Rejection, T cells
Session Information
Session Name: Poster Session C: Kidney: Acute Cellular Rejection
Session Type: Poster Session
Date: Monday, June 3, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Low levels of renal allograft inflammation in the early post transplant period appear to have an impact on renal architecture and function. However, the differential impact of interstitial inflammation and tubulitis at 3 months on chronicity, renal function, development of de novo DSA and subsequent rejections is unclear.
*Methods: 802 patients underwent a de novo or repeat kidney transplantation (LD and DD)at our institution between 2013 and 2016 and were followed till Oct 2018. After excluding graft losses within the first 3 months, T-Cell Mediated Rejection (Clinical and Subclinical), Antibody Mediated Rejection (Clinical and subclinical) and BK virus nephropathy, the remaining 418 patients were divided on the basis of their 3 month biopsy, into No Inflammation NI (n=149 with i0t0); Isolated Interstitial Inflammation IIF (n=82 with 0< i <2; t0) and Interstitial Inflammation with Tubulitis, IF+T (n=187 with 0< i <2 and 0< t <2 but not qualifying for Banff IA rejection). Almost all patients received thymoglobulin and were maintained on a steroid free regimen with tacrolimus and cellcept. NI was used as the baseline group.
*Results: The demographics in the 3 groups were comparable with regard to age, sex, race, HLA mismatches, PRA, induction and maintenance therapy, DGF and tacrolimus levels. 1. The chronicity changes at 1 year were worse in IF+T vs NI “$$table”. 2. Subsequent rejections (SC-TCMR and clinical TCMR) upto 1 year were higher in IF+T ( 11.5 vs 11% vs 23%; IF+T vs NI p<0.01; IIF vs NI p 0.2) 3. De novo DSA development upto 2 yrs was higher in IF+T(1 vs 3 vs 9 ; IF+T vs NI p=0.03; IIF vs NI p 0.1) 4. Renal function was worse in IF+T at 1 and 2 yrs "$$table"
*Conclusions: Presence of low grade interstitial inflammation with tubulitis appears to have a deleterious impact compared to interstitial inflammation alone on: 1. Renal Function upto 2 years 2. Subsequent TCMR (Clinical and Subclinical) within first year 3. Development of de novo DSA and 4. Allograft histology (IFTA) at 1 year
| NI | IIF | IF+T | IIF vs NI p value | IF+T vs NI p value | |
| Cr 3m | 1.45(0.5) | 1.46(0.5) | 1.57(0.6) | 1.0 | 0.11 |
| Cr 1y | 1.38(0.5) | 1.54(0.6) | 1.62(0.8) | 0.24 | 0.004 |
| Cr 2y | 1.43(0.6) | 1.49(0.6) | 1.67(0.8) | 1.0 | 0.011 |
| IFTA 3m(%) | 0 | 0 | 2 | 1.0 | 0.2 |
| IFTA 1y(%) | 7 | 9 | 23 | 0.6 | <0.01 |
To cite this abstract in AMA style:
Mehta R, Tandukar S, Jorgensen D, Owoyemi I, Sood P, Tevar A, Hariharan S. Outcomes of Phenotypes in Early Subclinical Inflammation (SCI) Determined by Presence of Interstitial Inflammation with or without Concomitant Tubulitis [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-phenotypes-in-early-subclinical-inflammation-sci-determined-by-presence-of-interstitial-inflammation-with-or-without-concomitant-tubulitis/. Accessed November 22, 2024.« Back to 2019 American Transplant Congress