Session Time: 3:15pm-4:45pm
Presentation Time: 4:27pm-4:39pm
*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.
|Group||Number (n)||Number of pts with subsequent TCMR during 5y f/u||Proportion of pts with subsequent rejections||P value|
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 October 20, 2020.
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