Date: Tuesday, June 5, 2018
Session Name: Concurrent Session: Kidney: Acute Cellular Rejection
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Room 6A
Renal allograft microcirculation inflammation (MI) lesions including glomerulitis (g) and peritubular capillaritis (ptc) are associated with AMR and poor outcomes. The significance of MI lesions detected in the early post-transplant period in patients without AMR is unknown. In this prospective study, we examined MI lesions in the early post-transplant period and their association with TCMR.
Subjects: 294/372 KTRs had serial biopsies (for-cause & protocol:3&12mo) and DSA assessment through the first year. 36.7% (N=108) patients in this study experienced TCMR (17.3% clinical (ACR) & 18.4% sub-clinical (SCR)) in the first year. 3.7% of the patients (n=11) had concomitant AMR.
MI lesions: Of the 294 KTRs, 27.6% (n=81) had detectable MI lesions in the 1st year. Whilst 31 KTRs (10.5%) had 'g' lesions and 18 (6.1%) had 'ptc' lesions alone, 32 (11%) KTRs had both 'g' and 'ptc' lesions. Further, 39.5%of these 81 KTRs, had 'g+ptc' score≥2.
MI lesions and TCMR: 14.7% of patients with no TCMR, 19.7% with Borderline changes, 40.3% with Banff 1A and 54% with Banff ≥1B had MI lesions (p<0.0001). Even after excluding AMR, 46.2% of KTRs with isolated TCMR had these lesions. Importantly, 38% of the patients with SCR had these lesions in comparison to 16% with no rejection and 55% with ACR (p<0.0001).
MI lesions & Outcomes: MI lesions were associated with significantly worse IFTA (p-=0.004) and increased graft loss or impending graft loss (eGFR<30ml/min & >30% decline from baseline) (Fig 1A, 1B). Importantly, in combination with TCMR, these lesions were associated with the worst IFTA scores (p<0.001) and graft outcome (Fig1C). Thus patients with MI+TCMR represent a very high risk group for poor graft outcomes.
Risk factors for MI+TCMR: In a multivariate logistic regression model, post-transplant DSA (OR 2.7, p=0.02) and non-adherence (OR 3.3, p=0.001) defined by high CNI intra-patient variability (>35%) were independently associated with MI+TCMR
Conclusions: Thus, we show that MI lesions are associated with isolated TCMR. Furthermore, post-transplant DSA and non-adherence are risk factors for the development of MI+TCMR, a phenotype associated with poor graft outcomes.
CITATION INFORMATION: Cherukuri A., Chittka D., Mehta R., Sharma A., Sood P., Hariharan S. Early Microcirculation Inflammation Associated with TCMR Leads to Poor Graft Outcomes in Kidney Transplant Recipients (KTRs) Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Cherukuri A, Chittka D, Mehta R, Sharma A, Sood P, Hariharan S. Early Microcirculation Inflammation Associated with TCMR Leads to Poor Graft Outcomes in Kidney Transplant Recipients (KTRs) [abstract]. https://atcmeetingabstracts.com/abstract/early-microcirculation-inflammation-associated-with-tcmr-leads-to-poor-graft-outcomes-in-kidney-transplant-recipients-ktrs/. Accessed December 14, 2019.
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