*Purpose: Early graft loss after kidney transplantation (KT) is mainly a result of acute rejection, while long-term graft loss episodes are often dependent on multifactorial conditions. Both short- and long-term graft survival have improved in the last decade, however, the short-term results are still superior to the long-term outcomes. In this study we wanted to explore if patients with subclinical inflammation 10 weeks after KT had increased risk of long-term graft loss (GL).

*Methods: We measured 21 inflammatory biomarkers 10 weeks after KT in 1044 patients without any sign of acute inflammation and/or ongoing rejection episodes. Low-grade inflammation was assessed as composite inflammation scores: one overall inflammation score, and additionally five pathway-specific scores (table 1). The scores were tested in Cox regression models adjusted for traditional risk factors.

*Results: During the study period, 410 (39.3%) patients experienced overall GL, and of these 145 (35.6%) were death-censored GL. The overall inflammation score was significantly associated with overall GL (2^nd quartile HR 1.60, p=0.001, 3^rd quartile HR 1.87, p<0.001, 4^th quartile HR 3.54, p<0.001), and with death-censored GL (2^ndquartile HR 1.22, p= 0.504, 3^rd quartile HR 1.78, p=0.049, 4^th quartile HR 3.32, p<0.001) (figure 1 and 2). The same pattern was present for the pathway-specific scores and overall GL, whereas only fibrogenesis, vascular-, and metabolic inflammation showed a significant association with death-censored GL.

*Conclusions: It appears to be a strong association between subclinical general inflammation in the early period after KT and both long-term overall- and death-censored GL. These results establish the foundation for future studies on follow-up strategies and possibly new therapeutic approaches.

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