Acute rejection (AR) Banff grade (BG) correlates with long-term graft survival, however, previous validation studies did not account for rejection type (acute cellular rejection (ACR)/antibody mediated rejection (AMR)/mixed AR). Similarly, BG validation has not been performed for early and late AR. Purpose: to assess the effect of BG for “pure” ACR (ie, ACR without concomitant AMR and without a donor specific antibody (DSA)) in both early and late AR.

Methods: First AR episode BG in 111 patients between 1/05 and 10/12 were identified in a prospective database. ACR was defined by Banff criteria: borderline AR, AMR, mixed AR, and ACR with associated DSA were excluded. Early and late AR were defined as < or > 6 months post-txp.

Results: Median follow-up post-rejection was 686 days (1-2573). Overall patient survival was 87% and death-censored graft survival (DCGS) was 82%. The 7 BG subgroups (see table) were similar with respect to age, gender, African American race, repeat txp or delayed graft function. No statistical difference in DCGS was observed when all early ACR as a group were compared to all late ACR (p=0.10). Significant reductions in DCGS were observed between individual BGs for early ACR (p=0.051), and also between individual BGs for late ACR (p=<0.001)(see Figure). Among all 7 subgroups of BGs from early and late ACR, DCGS was worst with late ACR BG 2A. In addition a significant difference was observed in DCGS between early ACR BG 2A and late ACR BG 2A (p=<0.001). No difference was observed in DCGS between early and late BG 1A (p=0.24) and early and late BG 1B (p=0.31).

Conclusion:

1. DCGS was numerically worse (p=0.10) for early vs. late ACR

2. DCGS decreased with increasing BG in early ACR and late ACR

3. Early Banff 1a ACR (ie, ACR without a humoral component) is not associated with decreased DCGS.

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