Association of Histological Findings in Renal Graft Biopsy with Non-Adherence to Immunosuppressive Treatment
1Department of Nephrology and Kidney Transplantation/ Post Graduation Program in Pathology, Irmandade Santa Casa de Misericórdia/ Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil, 2Transplant Immunology Laboratory,, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil, 3Department of Pathology, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil, 4Department of Nephrology and Kidney Transplantation, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil, 5Transplant Immunology Laboratory, Irmandade Santa Casa de Misericórdia, Porto Alegre, Brazil, 6Renal Transplant Unit, NIEPEN/NIDEAL (UFJF), Porto Alegre, Brazil
Meeting: 2019 American Transplant Congress
Abstract number: C55
Keywords: Biopsy, Immunosuppression, Kidney transplantation
Session Information
Session Name: Poster Session C: Kidney Complications: Late Graft Failure
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: Non-adherence to immunosuppressive treatment after renal transplantation is a frequent issue, but the magnitude of its impact has been debated. It is unknown whether the histology of acute rejection in non-adherent (NAd) renal transplant patients differs from that of adherent (Ad) patients. The presence of Plasma cell-rich infiltrates (PCi) in the acute cellular rejection are poorly addressed and there seems to be a relationship with a nonadherence to immunosuppressive treatment. In the few existing studies, the response to anti-rejection therapy was less satisfactory and the graft survival rates were lower in cases of acute cellular rejection with PCi
*Methods: This is a prospective, cross-sectional study in a single center. Patients with clinical indication for renal biopsy were analyzed for adherence to treatment by three methods, (1) the Basel Assessment of Adherence Scale for Immunosuppressives (BAASIS; self-report), (2) blood levels of immunosuppressive drugs (direct method), and assistant medical opinion and for changes in renal biopsy according to Banff classification
*Results: In total, 154 renal graft biopsies from 131 adult recipients were analyzed. Of these, 111 patients (72%) were considered NAd. Plasma cell-rich infiltrates (PCi) were described in 67 biopsies, 54 (p = 0.02) of which were from NAd patients. Furthermore, biopsies from NAd patients had a higher mean percentage (17.84%) of interstitial fibrosis and tubular atrophy (95% CI 15.16-20.53) (p = 0.015). Eighteen out of 101 patients had de novo DSA at the time of biopsy, most of which (16) were NAd patients (p = 0.053).
*Conclusions: The higher prevalence of PCi in NAd patients as compared with Ad patients shows the importance of monitoring adherence to treatment in the post-transplant period to identify NAd patients and thus prevent late severe rejection.
To cite this abstract in AMA style:
Cardoso BD, Montagner J, Pegas K, Kist R, Neumann J, Pinheiro HS, Garcia VD, Keitel E. Association of Histological Findings in Renal Graft Biopsy with Non-Adherence to Immunosuppressive Treatment [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/association-of-histological-findings-in-renal-graft-biopsy-with-non-adherence-to-immunosuppressive-treatment/. Accessed May 11, 2025.« Back to 2019 American Transplant Congress