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 December 7, 2019.
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