A Prospective Study of Renal Function and Histological Changes in Renal Transplant Recipients With Acute Clinical and Subclinical Rejection

S. Chen,¹ R. Mehta,¹ P. Sood,¹ P. Randhawa,² N. Shah,¹ C. Wu,¹ A. Tevar,³ S. Hariharan.¹

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.

Table 1
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 May 9, 2025.

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