The risk factors for graft loss in kidney transplant recipients (KTR) with non-adherence (NA) to immunosupression who present with rejection are not known.

We analyzed 208 NA KTR with biopsy (bx) proven acute rejection (AR) from 1984-2012. Proportional hazards regression was used to analyze time from bx to graft failure, adjusting for the following covariates: demographics, treatment of acute rejection (AR),serum creatinine (cr) at the bx, time from transplant to bx and severity of AR and chronic rejection (CR) (per Banff schema).

Results: Mean time from transplant to bx was 26.1 mos±38.7. Eighty four recipients (41%) did not receive any treatment for AR (group 1), while the remaining patients received either depleting antibody [n=27; 13.2% -group 2] or steroids alone [n=93; 45.6% -group 3]. Mean cr [mg/dl] was 5.0±5.8, 2.8±1.8 and 2.8±2.2 in groups 1,2 and 3 respectively. Mean AR grade was borderline, 1B and 1A in group 1,2 and 3 respectively (p<0.0001). There was no difference in chronicity grade between the groups.

In multivariate analysis, only higher cr at bx (by 1.0 mg/dl) and higher CR grade was associated with an increased risk of graft failure (Table1).

When graft outcomes were analyzed based on the Cr levels at the time of bx, adjusted for other covariates, risk for graft failure was the highest in recipients with creatinine >7 mg/dl (Table 2)

There was no difference in actuarial graft survival between treatment groups.

Conclusion: Higher Cr at biopsy and higher CR grade predicts graft loss in non-adherent KTRs. Treatment of AR may not prolong graft survival in NA patients, especially if advanced CR is present.

« Back to 2013 American Transplant Congress