Clinical Outcome in Pure T-Cell Mediated Acute Rejection of the Kidney with No Donor Specific Antibody or C4d Staining.
1Department of Pathology, The Thomas E Starzl Transplantation Institute, Pittsburgh, PA
2Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
3Department of General Surgery, Friendship Hospital, Capital Medical Universit, Beijing, China.
Meeting: 2016 American Transplant Congress
Abstract number: A165
Keywords: Kidney transplantation, Rejection, T cells
Session Information
Date: Saturday, June 11, 2016
Session Name: Poster Session A: Kidney: Acute Cellular Rejection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Background: T-cell mediated rejection (TCMR) is now considered to have little impact on renal graft function. This study re-evaluated the histologic phenotypes and clinical significance of pure acute and chronic TCMR in the era of “C4d staining, routine DSA testing and ABMR”.
Methods: Biopsies fulfilling Banff criteria for TCMR were retrieved, and those with C4d deposition or associated DSA excluded. Control cases consisted of renal allograft biopsies with no histologic evidence of TCMR, C4d staining, infection,thrombotic microangiopathy, or glomerulonephritis.
Results: In a review of 543 specimens, DSA within 30 days of biopsies were more common in patients with acute rejection compared to controls (197/356= 55% vs. 21/57=36%; p=0.02). This indicates that kidney transplant patients tend to turn on both arms of the immune system during rejection. In all 7.8% of biopsies were classified as pure TCMR (10 borderline, 18 at least Grade 1A). The other principal diagnoses in order of frequency were chronic mixed antibody and T-cell mediated injury(28.3 %), interstitial fibrosis/tubular atrophy(17.1 %), chronic allograft arteriopathy(3.3%), recurrent or denovo glomerular disease(1.3%), pyelonephritis(0.9%), and thrombotic microangiopathy(0.2%). On clinical follow up, creatinine showed complete remission in 7/10(70%) borderline and 9/18(50%) TCMR (grade 1A or above) patients 1m post-biopsy. Longer observation showed that untreated cases were was associated with a progressive rise in creatinine and estimated GFR at 6, 12, 24 months. In the control group, low interstitial fibrosis score predicted spontaneous remission of graft dysfunction at 3 months(p=0.05). In the TCMR group trends were found for low arteriosclerosis score, fibrosis score, and tubular atrophy score (0.09) but did not reach statistical significance.
Conclusions: TCMR without DSA or complement deposition has adverse consequences on graft function.T-cell based clinical monitoring and therapy remains relevant in optimal care of kidney transplant patients.
CITATION INFORMATION: Randhawa P, Huang G, Randhawa S, Zeng G, Zhao X. Clinical Outcome in Pure T-Cell Mediated Acute Rejection of the Kidney with No Donor Specific Antibody or C4d Staining. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Randhawa P, Huang G, Randhawa S, Zeng G, Zhao X. Clinical Outcome in Pure T-Cell Mediated Acute Rejection of the Kidney with No Donor Specific Antibody or C4d Staining. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-outcome-in-pure-t-cell-mediated-acute-rejection-of-the-kidney-with-no-donor-specific-antibody-or-c4d-staining/. Accessed April 21, 2019.« Back to 2016 American Transplant Congress