*Purpose: The significance of borderline changes suspicious for rejection noted on early renal allograft biopsies on subsequent events in renal transplant recipients is unclear.

*Methods: Between Jan 2013 and Dec 2016, a total of 802 patients underwent a kidney transplant at our institute (LD and DD). Graft losses within the first year, inadequate biopsies, biopsies meeting criteria for T Cell Mediated Rejection, Antibody Mediated Rejection, BK nephritis, recurrent disease within the first 3 months post transplantation were excluded.The remaining 336 patients, on the basis of their 3 month biopsy were divided into Borderline Inflammation (BI)(n=187) with t score >0 with or without concomitant i score >0, but not meeting criteria for Banff IA rejection or higher; and No inflammation (NI)(n=149) with i0t0 scores.The induction regimen comprised of thymoglobulin and maintenance regimen comprised of tacrolimus and MMF.

*Results: Donor and recipient demographics, including age, sex, race, PRA, HLA mm, tacrolimus levels, DGF and cold ischemia time in the 2 groups were similar. 1. Subsequent TCMR, both clinical and subclinical till 1 year were noted to be higher in BI compared to NI (23% vs 11.5%; p<0.01) 2. IFTA scores (ct+ci >2) at 1 year biopsy were also higher in BI (23% vs 7%; p<0.01). 3. De novo DSA was higher in BI (9 vs 1; p=0.03) 4. Renal function was worse at 1 yr and 2 yrs in BI "$$table"

*Conclusions: Borderline changes noted in early transplant allograft biopsies have a negative impact on: 1. Renal function up to 2 years 2. Allograft chronicity (IFTA) 3. development of de novo DSA during the first 2 years post transplant and 4. Subsequent rejections (Clinical and Subclinical TCMR) during the first year post transplant.

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