Session Name: Biomarkers, Immune Assessment and Clinical Outcomes
Session Date & Time: None. Available on demand.
*Purpose: We hypothesize that Subclinical Acute Rejection (SubAR) under the new Banff 2019 criteria will be more strongly associated with a 2-year composite endpoint (2Y-CCE) than previous criteria.
*Methods: SubAR and 2Y-CCE were assessed in a previously studied patient cohort. SubAR was defined as histology on a surveillance biopsy consistent with acute rejection (≥Banff borderline changes and/or antibody-mediated rejection). Transplant excellent (TX) was defined as negative histology for acute rejection. 2Y-CCE was defined as any of the following: evidence of ≥ Banff grade II IFTA at 2-year biopsy, biopsy-proven rejection on “for-cause biopsy,” or a decrease in eGFR by >10 m/min/1.73m2. For logistic regression analysis, subjects were divided into three groups (because subjects had more than one biopsy in the trial) based on biopsy sample classification under 2019 and 2007 criteria: 1) subAR-only, 2) TX-only, 3) subAR and TX (mixed).
*Results: 253 unique subjects with 551 biopsy samples were assessed. Of these, 192 subjects with 444 samples had 2Y-CCE results and were eligible for analysis, 1) subAR only (2019 Banff: n=13; 2007 Banff: n=21), 2) TX only (n=141; n=106), 3) mixed (episodes of both subAR and TX) (n=38; n=65) (Figure 1). A total of 82 subjects reached 2Y-CCE under either set of criteria (n=82). 65 borderline samples were reclassified to TX by the 2019 Banff criteria (Table1). The subAR-only group was found to have a significantly higher odds ratio (OR) for developing 2Y-CCE than the TX-only group under both 2007 (OR = 19.27 (95% CI [4.25, 87.42], p =0.001)) and 2019 (OR = 19.33 (CI [2.44, 152.92], p =0.01) Banff criteria. The SubAR only group by 2019 Banff criteria had a slightly stronger association with 2Y-CCE than by 2007 criteria. There was no significant association with developing 2Y-CCE between the TX-only group and the mixed group under 2007 and 2019 Banff criteria.
*Conclusions: The subAR only group classified by 2019 Banff criteria, which brought an increase in the diagnostic threshold for borderline changes, showed slightly stronger association with developing 2Y-CCE than by 2007 Banff criteria. The subAR group classified with either criteria are significantly associated with 2Y-CCE compared to the Tx only group. Further investigation is warranted with a larger cohort and longer follow-up to evaluate the impact of the prognostic ability of the new 2019 Banff criteria.
To cite this abstract in AMA style:Victor MT, Park S, Guo K, Zhao L, Friedewald J. Is Subclinical Allograft Rejection by 2019 Banff Criteria Associated with Worse Kidney Allograft Outcomes? Comparison Between 2007 and 2019 Banff Criteria [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/is-subclinical-allograft-rejection-by-2019-banff-criteria-associated-with-worse-kidney-allograft-outcomes-comparison-between-2007-and-2019-banff-criteria/. Accessed September 23, 2021.
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