Impact of T-cell Mediated Allograft Inflammation within First-Year after Kidney Transplantation: An Analysis of Paired Biopsies from a Single Center Study

S. Tandukar, R. Mehta, I. Owoyemi, D. Jorgensen, P. Sood, S. Hariharan

Division of Transplant Nephrology, Thomas E. Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA

Meeting: 2019 American Transplant Congress

Abstract number: C168

Keywords: Biopsy, Graft function, Graft survival, Kidney transplantation

Session Information

Session Name: Poster Session C: Kidney: Acute Cellular Rejection

Session Type: Poster Session

Date: Monday, June 3, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: We evaluated the impact of Clinical and Sub-Clinical T-Cell-Mediated Rejection (TCMR) and Sub-Clinical Inflammation (SCI) within 1 year post-transplant.

*Methods: Adult kidney transplant patients who underwent transplants between Jan, 2013 and Dec, 2016 and biopsies at 3&12-months were included. Patients with ABMR, BKVN and those who lost the graft within 1 year were excluded. Patients were divided into 4-groups: GR-I: No inflammation(NI) in both biopsies, GR-II: Subclinical-Inflammation(SCI) in at least 1 biopsy, GR-III: SC-TCMR in at least 1 biopsy and GR-IV: C-TCMR in at least 1 biopsy. Sum of acute (t,i,g,v) and chronic (ct,ci,cg,cv) histologic scores were compared. The outcomes measures included serum creatinine, eGFR and the burden of renal disease (AUC: serum creatinine mg*month/dL) for each group from 3 month-last follow-up. In addition, Graft-Loss and Impending Graft-Loss (eGFR<20 mL/min per 1.73 m²) were measured at last follow up upto Oct, 2018.

*Results: Recipient and donor demographics, variables (ESRD cause and duration, PRA I/II, CMV/EBV status, induction, CIT, WIT) were similar across groups. The mean KDPI was significantly lower in Gr-I(NI), p=0.02. Table-1 shows higher acute and chronic allograft histology scores at 3/12 months, and higher cumulative renal dysfunction (AUC) among those with C-TCMR, followed by SC-TCMR and SCI compared to NI. Combination of graft loss and impending graft loss was higher among patients with C-TCMR. Figure-1 shows lower KM composite graft survival for C-TCMR group.

Graft loss and allograft histologic scores at 3- and 12-months post-transplant
Outcomes (Mean+SD)	Group-I No inflammation N=41	Group-II Subclinical Inflammation N=193	Group III-Subclinical TCMR N=95	Group-IV Clinical-TCMR N=58	p-value
Graft loss,%	7.3	2.1	2.1	6.9	0.57
Impending graft loss,%	4.9	3.6	4.2	19.0	0.0002
Graft loss and impending graftloss,%	12.2	5.7	6.3	25.9	<0.0001
Delta-Creatinine mg/dL (6month-last follow-up)	0.1+1.1	0.2+1.4	0.1+1.0	0.9+2.8	0.02
Creatinine AUC,mg*month/dL	52.0+5.9	57.6+2.7	62.9+3.9	90.2+4.9	<0.0001
3-month Acute-Score/Chronic-Score	0+0/0.9+1.1	1.1+1.0/1.8+1.3	2.4+1.7/2.1+1.3	3.1+2.0/2.7+1.6	<0.0001/<0.0001
12-month Acute-Score/Chronic-Score	0.1+0.3/1.5+1.0	1.3+1.1/2.4+1.4	3.5+1.8/3.3+1.3	3.6+2.1/3.8+1.5	<0.0001/<0.0001

*Conclusions: C-TCMR, SC-TCMR and SCI within 1-year were associated with heightened acute and chronic allograft scores. C-TCMR within 1-year post-transplant is associated with worse renal function over follow-up and is a predictor of combined graft loss and impending graft loss.

To cite this abstract in AMA style:

Tandukar S, Mehta R, Owoyemi I, Jorgensen D, Sood P, Hariharan S. Impact of T-cell Mediated Allograft Inflammation within First-Year after Kidney Transplantation: An Analysis of Paired Biopsies from a Single Center Study [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-t-cell-mediated-allograft-inflammation-within-first-year-after-kidney-transplantation-an-analysis-of-paired-biopsies-from-a-single-center-study/. Accessed June 21, 2025.

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