It is debatable whether creatinine can serve as a surrogate marker of rejection reversal. The purpose of the current study was to evaluate the change in creatinine following initiation of rejection treatment as it relates to post-treatment renal biopsies. We evaluated 109 first episodes of biopsy proven acute rejection. Of those patients, 42 (39%) had a post-treatment biopsy and were included in the analysis. Post-treatment biopsies were categorized as complete/near complete (i.e. downgraded to borderline) resolution (R) or partial (downgraded by 1 BANFF grade)/persistent (P). Pure-antibody mediated rejections were excluded from the analysis. Mean age was 49±14 years, 60% were male, 55% were Caucasian, 64% were deceased donors, 14% were re-transplants and mean/median time to rejection were 13/8 months. Twenty-five and 17 patients were included in the R and P groups, respectively. Rejection characteristics are shown below. There were more mixed and grade 2 or higher rejection episodes in the P group, but the difference was not significant most likely due to the small number of patients. There was no difference in the percent change in creatinine at any time point between the R and P groups.

Those in the P group had significantly worse graft survival post-rejection when compared to those in the R group (p=0.003).

Therefore, there does not appear to be a correlation between change in creatinine and rejection resolution based on biopsy. This data highlights the importance of post-treatment biopsies to verify rejection resolution.

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