Early Inflammatory Lesions on Surveillance Biopsies Post Kidney Transplant is Associated with Increased Incidence of Late Clinical Rejections

I. Melgarejo¹, D. Jorgensen², K. Kalra¹, S. Tandukar², C. Puttarajappa², N. Shah², A. Sharma², P. Sood², C. Wu², S. Hariharan², R. Mehta²

¹Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, ²Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA

Meeting: 2020 American Transplant Congress

Abstract number: 462

Keywords: Kidney, Outcome, Rejection

Session Information

Session Name: Kidney: Acute Cellular Rejection

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 4:27pm-4:39pm

Location: Virtual

*Purpose: It is unclear whether subclinical inflammation (or subclinical rejection) noted on early post transplant biopsies are associated with late clinical rejections (beyond 6 months).

*Methods: Patients transplanted (live donor and deceased donor) at our center between Jan 2013 through Dec 2016 were considered for this study if they underwent an early biopsy (either indication or surveillance biopsy within first 5 months post transplant). Out of 802 patients, a total of 569 patients were eligible and were divided into 1. NI (n=149; t=0 and i=0); 2. SCI (n=266; t>0 and/or i>0 but not meeting criteria for Banff IA rejection; 3. SC-TCMR (n=63; Banff IA or higher on surveillance biopsy); and 4. C-TCMR (n=91); Banff IA or higher and mixed TCMR and AMR). The NI group was used as a negative comparator. TCMR and AMR was treated per institution protocol. We followed all groups for subsequent clinical rejections for a maximum duration of 6 years and median of 3 years. Induction regimen included thymoglobulin (>95% of pts). Maintenance regimen comprised of CNI with MPA.

*Results: See Table 1.

Table 1
Group	Number (n)	Number of pts with subsequent TCMR during 5y f/u	Proportion of pts with subsequent rejections	P value
NI	149	25	16.7%
SCI	266	73	27.4%	0.01
SC-TCMR	63	26	41.3%	<0.001
C-TCMR	91	43	47.2%	<0.001

There were no differences in the age, sex, HLA mismatches, PRA or other demographics between the two groups. Odds Ratio for late clinical rejection was 1.9 (95% CI 1.1-3.1; p=0.01) for the SCI group; 3 (95% CI 1.6-5.7; p<0.001)for the SC-TCMR and 4.4 (95% CI 2.5-8.1; p<0.001) for the C-TCMR group.

*Conclusions: 1. The odds of having clinical rejection was almost two fold higher in patients with subclinical inflammation and threefold higher in patients with subclinical rejection noted on early surveillance biopsies.2. Early silent inflammation noted on biopsies is not benign and is associated with a higher incidence of late clinical rejections. Immunosuppression should be optimized for several years in this subgroup of patients.

To cite this abstract in AMA style:

Melgarejo I, Jorgensen D, Kalra K, Tandukar S, Puttarajappa C, Shah N, Sharma A, Sood P, Wu C, Hariharan S, Mehta R. Early Inflammatory Lesions on Surveillance Biopsies Post Kidney Transplant is Associated with Increased Incidence of Late Clinical Rejections [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/early-inflammatory-lesions-on-surveillance-biopsies-post-kidney-transplant-is-associated-with-increased-incidence-of-late-clinical-rejections/. Accessed May 11, 2025.

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