Date: Saturday, June 11, 2016
Session Name: Poster Session A: Kidney: Acute Cellular Rejection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Halls C&D
Purpose:Hyperlipidemia (HLD) has been associated with more robust immune response, possibly increasing risk for rejection. Recent articles have associated HLD with increased IL-17 production and anti-donor cells, as well as alterations to regulatory T-cell function.
Methods: We performed a retrospective cohort study of adult kidney transplant recipients at one center (1999-2014) who had a lipid panel drawn prior to transplantation and were initially on tacrolimus post-transplant (post-txp). We evaluated predictors for rejection (adjusted hazard ratio, aHR) utilizing a backwards-stepwise Cox regression model including lipid-related parameters, statin exposure at 1 month post-txp, lipid levels, as well as covariates associated with rejection. Acute cellular rejection (ACR) was defined as biopsy-proven cellular rejection (Banff criteria) occurring at any time post-txp, and only first occurrences were included.
Results: There were 1800 patients with evaluable data during this timeframe, among whom median pre-transplant (pre-txp) triglyceride (TG) level was 139 mg/dL. Induction immunosuppression was mainly anti-thymocyte globulin with 87.7% of patients receiving and 90.5% were initially maintained on mycophenolate, all patients were maintained on steroids. In total, 121 (6.7%) experienced ACR. The median time to ACR was 9.2 months post-txp.
|No ACR||ACR||p value|
|Male Sex (%)||59.2||60.3||0.810|
|Black Race (%)||20.7||27.2||0.075|
|Deceased Donor (%)||63.2||31.0||0.678|
|Albumin at transplant (mg/dL)||3.5||3.7||0.007|
|BMI at transplant (kg/m2)||28.1||28.4||0.530|
|HDL pre-txp (mg/dL)||49||45||0.032|
|LDL pre-txp (mg/dL)||80||75||0.233|
|TG pre-txp (mg/dL)||139||151||0.076|
Each 50 mg/dL increase in pre-txp TG was associated with a 5.0% increase in the relative risk of ACR (aHR 1.050). Additional factors associated with ACR included age at transplant (aHR 0.962), black race (aHR 1.596), active smoking history (aHR 2.46), and year of transplant (aHR 0.856). Treatment with statins in the first month post-txp did not affect rates of ACR.
Conclusion: Higher pretansplant TG levels are associated with increased risk of ACR after kidney transplant. Further study is warranted to determine is statin treatment mitigates ACR risk in patients with hypertriglyceridemia before transplantation.
CITATION INFORMATION: Hagopian J, Brennan D, Lentine K, Horwedel T. Higher Pre-Transplant Triglyceride Levels Are Associated with Increased Acute Cellular Rejection Risk Following Kidney Transplant. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Hagopian J, Brennan D, Lentine K, Horwedel T. Higher Pre-Transplant Triglyceride Levels Are Associated with Increased Acute Cellular Rejection Risk Following Kidney Transplant. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/higher-pre-transplant-triglyceride-levels-are-associated-with-increased-acute-cellular-rejection-risk-following-kidney-transplant/. Accessed June 4, 2020.
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