Background: Acute T-cell-mediated rejection (TCMR) is divided by Banff classification into tubulo-interstitial rejection and vascular rejection according to the presence of arteritis. Vascular rejection is supposed to have inferior effects on graft outcome. We performed a retrospective analysis to detect whether the distinction between TCMR Ib (presenting severe tubulitis) and TCMR IIa (presenting mild intimal arteritis) is relevant to short- and long-term graft outcomes. Methods: 110 adult patients (pts) were recruited in this study, who underwent single kidney transplantation (Tx) between 1996 and 2010 in our clinic and whose worst episodes of indicative biopsies were proven as acute TCMR Ib or IIa. The 110 biopsies were divided into two parts relying on the time of TCMR: early onset (≤6 months post Tx) vs. late onset (>6 months post Tx). Kaplan-Meier graphs were analyzed for graft survival; Cox-regression was used to detect the risk factors for long term graft failure. Results: Pts in TCMR Ib and IIa group had the similar short- and long-term graft survival (10-years GS: TCMR Ib 61.7% vs. IIa 60.3%, log rank test p=0.36); in addition, the initial response to anti-rejection therapy was comparable between two groups (complete resolution 70.2% in TCMR Ib vs. 68.3% in TCMR IIa, p=0.83); the timing of biopsy played a critical role on graft outcome of pts with vascular rejection (10-years GS: 57.9% in late onset TCMR Ib vs. 10.0% in late onset TCMR IIa, p=0.02); but no significant difference was found between early onset Ib and IIa (64.3% vs. 69.8%, p=0.38); Furthermore, interstitial fibrosis (IF), tubular atrophy (TA) and hyaline arteriolopathy (ah) were three determinates of poor survival prognosis among scored pathologic Banff features; Regarding to clinic parameters, re-transplantation, more episodes of indicative biopsies, and the late onset of TCMR robustly associated with long-term graft loss; body mass index of recipients (BMI), serum creatinine (Scr) levels and donor age at biopsy correlated with the initial response to anti-rejection treatment. Conclusions: Episodes of TCMR Ib or IIa predict similar initial response to anti-rejection therapy and have the same prognostic value with regard to clinical outcomes; albeit the late onset of TCMR IIa has inferior graft outcome.
To cite this abstract in AMA style:Wu K, Rudolph B, Lu H, Schmidt D, Liefeldt L, Galender P, Neumayer H, Budde K. Acute T-Cell Mediated Rejection with Severe Tubulitis or Mild Intimal Arteritis: Which Histological Lesion Predicts Better Graft Outcome? [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/acute-t-cell-mediated-rejection-with-severe-tubulitis-or-mild-intimal-arteritis-which-histological-lesion-predicts-better-graft-outcome/. Accessed May 6, 2021.
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