*Purpose: Acute allograft rejection is considered one of the major causes of renal allograft dysfunction. Despite maximal anti-rejection therapy grafts may not regain baseline function. The aim of this study is to investigate the relationship of acute rejection episodes treated with r-ATG one year post transplantation with reversibility of graft dysfunction and long-term graft survival / failure.

*Methods: We reviewed data of 23 recipients who received r-ATG between 2009 and 2018 for biopsy proven acute rejection. 12 recipients had received Deceased Donor Kidney Transplant. Mean age at transplant was 32.8+/-16 , 13 males, 13 Caucasians with biopsy proven acute rejection one year post transplant. Non-adherence was the most common reason for acute rejection (75%). r-ATG dose was 1 to 1.5 mg/kg for 5-8 days. All recipients received high dose IV steroids followed by oral Prednisone taper. Recipients were maintained on combination of Calcineurin Inhibitors, Mycophenolate and Prednisone. 17 had Banff 1B rejection and 6 with grade II or higher acute cell mediated rejection (ACMR). 6 recipients had combined ACR and Antibody mediated rejection and required treatment for antibody medicated rejection

*Results: Mean baseline Creatinine ( Cr) before acute rejection was 1.64 +/- 0.6. Cr at the time of biopsy was 5.08 +/- 2.8. Time lapse (days) between baseline Cr and Biopsy was 142 +/- 184 (Median 84 days) . Lowest mean Cr after r-ATG was at 1mo (3.24 +/-1.7mg/dl). Post r-ATG treatment Cr was 3.68 +/- 2.0 at 6 months. Twelve recipients had graft failure before 12 months. Mean Graft survival from date of transplant was 79.9+/-6.4 , Median of 71 months. Graft survival post r-ATG was 23.9 months +/- 5.2, Median of 17.5 months. Only 2 recipients had graft survival beyond 24 months

*Conclusions: Acute rejection one year post transplant severely reduces long term graft survival. Our findings suggest acute rejection treatment with r-ATG should be used in very selective patient

« Back to 2020 American Transplant Congress