Prognostic Relevance of Rejection Episodes Detected Within the First 3 Weeks After Kidney Transplantation

V. Arelin,¹ H. Schrem,² F. Lehner,² W. Gwinner,¹ H. Haller,¹ M. Schiffer.¹

¹Division of Nephrology and Hypertension, Department of Medicine, Hannover Medical School, Hannover, Lower Saxony, Germany
²General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany.

Meeting: 2015 American Transplant Congress

Abstract number: D157

Keywords: Biopsy, Graft function, Kidney transplantation, Rejection

Session Information

Session Name: Poster Session D: Kidney: Acute Rejection

Session Type: Poster Session

Date: Tuesday, May 5, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Background:

The relevance of cellular rejection events detected in the early phase after kidney transplantation for graft survival and function remains to be elucidated. Especially the Banff “borderline changes” fall short of a diagnosis of acute rejection with the recommendation that no treatment is a possible approach. So far these changes are used in combination with the clinical course for decision making if treatment is indicated. However it is unclear if “borderline changes” detected within the first 3 weeks after transplantation have any relevance.

Patients and methods: All cases with early biopsies after kidney transplantation performed in our center between 01.01.2007 and 31.05.2013 were evaluated (n=387). Median time between transplantation and first biopsy was 12 days (standard deviation 8 days). The main three indications for biopsies were delayed graft function (49%) or non-function (20%) and a rise in creatinine (31%). Study end-points were glomerular filtration rate (GFR, estimated with MDRD formula), serum creatinine levels, hemodialysis at hospital discharge and after one year as well as the number of rejection episodes and death during follow-up. The T-test, ANOVA, Pearson's Chi2 and the Wilcoxon tests were used for statistical analysis.

Results: No rejection was detected in 226 cases (58.9%), borderline rejection in 99 cases (25.8%) and Banff IA to III rejection in 62 cases (16.0%). Cases with no rejection and no treatment versus borderline rejection with predominant prednisolone bolus treatment (3×500 mg i.v., 90%) showed no significant difference in regard to the study endpoints (p>0.05). The treated patients had no significant number of rejection episodes during follow-up. Patients with borderline rejection versus Banff IA to III rejection had significantly lower creatinine levels and were significantly less frequently on hemodialysis after one year (p=0.049, t-test and p=0.023, Chi2 respectively).

Conclusion: Early borderline rejection has no impact on graft function after one year follow up. This could be due to adequate treatment. The value of early biopsies and the treatment of early borderline rejections should be investigated in a prospective randomized trial."

To cite this abstract in AMA style:

Arelin V, Schrem H, Lehner F, Gwinner W, Haller H, Schiffer M. Prognostic Relevance of Rejection Episodes Detected Within the First 3 Weeks After Kidney Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/prognostic-relevance-of-rejection-episodes-detected-within-the-first-3-weeks-after-kidney-transplantation/. Accessed May 9, 2025.

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