Late Subclinical Rejection and Borderline Rejection in Kidney Transplant Patients is Associated with Increased Incidence of Subsequent Clinical Rejections

V. Viswanathan¹, I. Melgarejo², C. Puttarajappa², P. Sood², M. Molinari², S. Hariharan², C. Wu², A. Sharma², N. Shah², R. Mehta²

¹Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA, ²Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA

Meeting: 2021 American Transplant Congress

Abstract number: 239

Keywords: Biopsy, Kidney, Rejection, Renal injury

Topic: Clinical Science » Kidney » Kidney: Acute Cellular Rejection

Session Information

Session Name: Kidney: Acute Cellular Rejection

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 7, 2021

Session Time: 4:30pm-5:30pm

Presentation Time: 5:00pm-5:05pm

Location: Virtual

*Purpose: The outcomes of inflammatory changes noted in late surveillance biopsies (1 year) is unclear.

*Methods: Patients transplanted (live donor and deceased donor) at our center between Jan 2013 through Dec 2017 were considered for this study if they underwent a late biopsy (at 1 year). Out of 1000 patients, a total of 410 patients were eligible and were divided into 1. NI (n=184; t=0 and i=0); 2. BLR (n=127; t>0 and i>0 but not meeting criteria for Banff IA rejection); and 3. SC-TCMR (n=99; i2t2 or higher on surveillance biopsy). The NI group was used as a negative comparator. TCMR and AMR was treated per institution protocol. We followed all groups for subsequent clinical rejections for a maximum duration of 7 years and median of 4 years. Induction regimen included thymoglobulin (>95% of pts). Maintenance regimen comprised of tacrolimus and mycophenolate mofetil.

*Results: There were no significant differences in age, sex, race, HLA mismatch, PRA or other demographics between the groups. Odds Ratio for subsequent clinical rejection was 4.1 (95% CI 1.7-10.7; p<0.001) for the BLR group; 5.6 (95% CI 2.3-14.4; p<0.001) for the SC-TCMR group.

*Conclusions: 1. The odds of having subsequent clinical rejection was 4 times higher in patients with borderline rejection and more than 5 times higher in patients with subclinical rejection noted on late surveillance biopsies. 2. It is important to identify these cohorts of patients with inflammatory lesions noted on late surveillance biopsies in order to closely monitor and treat subsequent rejections while optimizing immunosuppression.

Table 1
Group	Number(n)	Number of pts with subsequent rejection over 7y f/u	Proportion of patients with subsequent rejections	P value(compared to NI)
NI	184	7	3.8%
BLR	127	20	15.7%	<0.001
SC-TCMR	99	21	21.2%	<0.001
Total	410	48

To cite this abstract in AMA style:

Viswanathan V, Melgarejo I, Puttarajappa C, Sood P, Molinari M, Hariharan S, Wu C, Sharma A, Shah N, Mehta R. Late Subclinical Rejection and Borderline Rejection in Kidney Transplant Patients is Associated with Increased Incidence of Subsequent Clinical Rejections [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/late-subclinical-rejection-and-borderline-rejection-in-kidney-transplant-patients-is-associated-with-increased-incidence-of-subsequent-clinical-rejections/. Accessed May 11, 2025.

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