Magnitude of Pre-Biopsy Decline in Renal Function and Its Association with Allograft Rejection
1Division of Nephrology, UCSF, San Francisco, CA
2Department of Surgery, UCSF, San Francisco, CA
3Department of Epidemiology/Biostatistics, UCSF, San Francisco, CA.
Meeting: 2018 American Transplant Congress
Abstract number: A135
Keywords: Biopsy, Rejection, Renal dysfunction
Session Information
Session Name: Poster Session A: Kidney Acute Antibody Mediated Rejection
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Introduction: Acute rejection is a significant cause of morbidity, and transplant biopsy remains the gold standard for diagnosing rejection. To our knowledge there have been few studies defining the magnitude of decline in renal function that warrants performing a biopsy to rule out rejection.
Methods: We performed a single center, retrospective analysis of patients who underwent diagnostic transplant biopsy from 2006-2016, three months post-transplant. We evaluated the association between pre-biopsy decline in renal function and pathologic findings of rejection using logistic regression (adjusted for age, race, sex, diabetes, donor type, transplant year). Absolute rise in serum creatinine and percent change in eGFR by CKD-EPI equation were examined as predictors of rejection (cellular or antibody-mediated).
Results: 1,224 biopsies were analysed. Mean age was 46.3 years. 58.3% were men, and 18% were black. 53.5% of biopsies demonstrated rejection. Declines in eGFR of ≥20% were associated with higher odds of rejection compared to a <5% decline in eGFR. Rises in absolute serum creatinine by ≥0.3 mg/dL corresponded with a higher risk of rejection compared to rises in creatinine by <0.3 mg/dL.
| Percent Change in eGFR | Number of Biopsies | Unadjusted Odds Ratio (95% CI) | P value | Adjusted Odds Ratio (95% CI) | P value |
| <5% | 230 | 1.0 | ref | 1.0 | ref |
| 5-20% | 248 | 0.91 (0.63-1.32) | 0.61 | 0.93 (0.64-1.35) | 0.70 |
| 20-40% | 203 | 1.55 (1.08-2.22) | 0.02 | 1.65 (1.14-2.39) | 0.007 |
| >= 40% | 543 | 2.43 (1.73-3.42) | <0.001 | 2.33 (1.64-3.29) | <0.001 |
| Absolute rise in serum creatinine (mg/dL) | Number of biopsies | Unadjusted Odds Ratio (95% CI) | P Value | Adjusted Odds Ratio (95% CI) | P value |
| <0.3 | 437 | 1.0 | ref | 1.0 | ref |
| 0.3-0.6 | 201 | 1.68 (1.19-2.36) | 0.003 | 1.67 (1.19-2.37) | 0.003 |
| >=0.6 | 584 | 2.70 (2.09-3.50) | <0.001 | 2.55 (1.96-3.32) | <0.001 |
Conclusion: Decline in eGFR ≥20% or rise in serum creatinine by ≥0.3 mg/dL were associated with a higher risk of rejection. Changes in renal function of this magnitude may warrant prompt arrangement of biopsy given the high risk of rejection.
CITATION INFORMATION: Voora S., Ahearn P., Tavakol M., Johansen K., Ku E. Magnitude of Pre-Biopsy Decline in Renal Function and Its Association with Allograft Rejection Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Voora S, Ahearn P, Tavakol M, Johansen K, Ku E. Magnitude of Pre-Biopsy Decline in Renal Function and Its Association with Allograft Rejection [abstract]. https://atcmeetingabstracts.com/abstract/magnitude-of-pre-biopsy-decline-in-renal-function-and-its-association-with-allograft-rejection/. Accessed June 27, 2025.« Back to 2018 American Transplant Congress