Outcomes of Kidney Transplant Recipients with Early Allograft Inflammation: A Prospective Study

R. Mehta, S. Tandukar, P. Sood, C. Puttarajappa, C. Wu, N. Shah, A. Tevar, S. Hariharan.

University of Pittsburgh Medical Center, Pittsburgh.

Meeting: 2018 American Transplant Congress

Abstract number: D187

Keywords: Rejection

Session Information

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

Session Type: Poster Session

Date: Tuesday, June 5, 2018

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

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

Location: Hall 4EF

The impact of early allograft inflammation is unclear. We prospectively studied changes in renal function and histology in a cohort of patients who received a kidney transplant [LD(177)/DD(246)] under thymoglobulin induction, a steroid withdrawal protocol and Tac/MMF maintenance. A total of 596 patients were transplanted at our institution between Jan 2013 and December 2015. Twenty seven patients were excluded due to death or graft loss within the first 3 mths. Of the remaining, 423 patients underwent a biopsy at the 3 mth time point. Patients also underwent a 1 yr protocol biopsy and for cause biopsies. Subjects who had a 3 mth biopsy were prospectively followed for 2 yrs and based on this index biopsy, were divided into 4 Grps (n=423): 1. No inflammation (NI:n=116); 2. Subclinical Inflammation <Banff IA (SCI)(n= 196) including borderline rejection; 3. Subclinical Rejection (≥Banff IA)(SCR, n=52) and 4. Clinical Rejection (ACR; n=59). Subjects with inflammation on their biopsy, both clinical and subclinical were treated per center protocol. Ct+ci (IFTA) scores were calculated from the 1 yr biopsy. Donor, recipient and transplant variables were examined as potential risk factors for IFTA scores ≥2.

Results:

1. Renal function and IFTA score was worse in Groups 2,3 and 4

Group	Cr 3m	Cr 1y	Cr 2y	IFTA score
1 (n=116)NI	1.44(0.5)	1.4(0.48)	1.45(0.59)	1.32±0.9
2 (n=196)SCI	1.52(0.6)	1.57(0.62)	1.61(0.7)	1.93±1.1
3 (n=52)SCR	1.6(1.53)	1.73(0.53)	1.82(0.86)
4 (n=59)ACR	2.1(0.83)	1.89(0.99)	1.98(1.1)
p	<0.01	<0.01	<0.01	<0.01

2. DGF (OR 2.8; CI 1.3-6.2; p=0.01) and inflammation on 3 mth biopsy(Group 2,3 and 4)(OR 2.1; CI 1.2-3.8; p=0.01) were independent risk factor for development of IFTA

3. Subsequent rejections (SCR or ACR) followed upto 2 years were 10% in Group 1 vs 22% in Groups 2,3 and 4 combined (p<0.01 )

Conclusions:

1. Renal function was worse at 2 years in subjects with early allograft inflammation

2. DGF and allograft inflammation were independent risk factors for IFTA at 1 yr.

3. Rate of subsequent SCR or ACR was significantly higher in patients who had early allograft inflammation.

4. Low levels of inflammation as well as overt rejections early post transplant seem to have detrimental effects on renal function, histology and subsequent rejections.

CITATION INFORMATION: Mehta R., Tandukar S., Sood P., Puttarajappa C., Wu C., Shah N., Tevar A., Hariharan S. Outcomes of Kidney Transplant Recipients with Early Allograft Inflammation: A Prospective Study Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Mehta R, Tandukar S, Sood P, Puttarajappa C, Wu C, Shah N, Tevar A, Hariharan S. Outcomes of Kidney Transplant Recipients with Early Allograft Inflammation: A Prospective Study [abstract]. https://atcmeetingabstracts.com/abstract/outcomes-of-kidney-transplant-recipients-with-early-allograft-inflammation-a-prospective-study/. Accessed May 16, 2025.

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