The aim of this study was to analyze the characteristics of subclinical acute rejection and borderline change in protocol biopsies performed 3 months after kidney transplantation, and assessment of possible clinical and laboratory associations.
Between March 2010 and May 2012, 270 patients received kidney transplantation. Protocol biopsy was performed in 100 (37%) patients with stable renal allograft function at 3 months after transplantation. All patients had received induction therapy with basiliximab and were maintained on two or three immunosuppressive agents based on calcineurin inhibitors. The desensitization protocol in sensitized patients or ABO incompatible KT included pretransplant plasmapheresis and IVIG, with the addition of rituximab.
The renal allograft recipients with living donor were 68 (68%) and those with deceased donor were 32 (32%). In living donor transplantation, 20 patients were sensitized recipients, and 11 patients received ABO incompatible KT, 34 patients was conventional recipients. There were 46 patients (70.8%), 12 patients (18.5%) and 7 patients (10.8%) in the normal, borderline change and subclinical rejection, respectively. The mean estimated GFR in patients with subclinical rejection or borderline change was significantly lower than that in patients with normal histological group at 2 year after living donor transplantation, (50.75 ± 21.08 vs. 76.98± 18.27, P= 0.026). The ratio of borderline change and subclinical rejection was similar in patients with conventional, sensitized, and ABO incompatible in living donor KT. All case of C4d positive deposition was observed in either sensitized patients or ABO incompatible recipients. Positive C4d deposition was a significant association with positive donor specific antibodies. (Odds ratio 4.23, P = 0.049) This deposition, however, was not linked to antibody-mediated rejection.
Subclinical rejection and borderline change in high immunological risk patients was similar incidence with conventional allograft recipients in surveillance at the 3 months after kidney transplantation. C4d staining without evidence of rejection may represent a marker for stable graft accommodation in ABO incompatible renal allograft.
To cite this abstract in AMA style:Hong Y, Ahn G, Cho Y, Lee M, Kim J, Whang H, Chung B, Choi B, Park C, Kim Y, Yang C. Clinical Significance of Protocol Biopsy at Three Months after Kidney Transplantation: A Single Center Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/clinical-significance-of-protocol-biopsy-at-three-months-after-kidney-transplantation-a-single-center-experience/. Accessed July 24, 2021.
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