Management strategies for treatment of rejection post ktx vary among centers. Controlling minor degrees of inflammation can prevent chronic allograft scarring. To study the diverse practices, a national survey of program directors was sent through UNOS to all kidney programs in US. Of the 77 responders, 47 were nephrologists and 30 were surgeons. Of the centers that responded, 31 performed >100 transplants during 8/2016-7/2017. The use of thymo, Basiliximab or Campath for induction was reported in 83%, 46% and 21% of the centers, respectively. 64% responders do rapid steroid withdrawal while 36% do not. 62% responders reported the use Belatacept in select cases. MPA is the major anti-metabolite (99%). Fifty percent of responders who used basiliximab reported TCMR and ABMR rates of 5-10%. For diagnosing TCMR, 97% used indication biopsy, 26% used protocol biopsy, 3% used serum biomarkers and none used urine cytokines. For ABMR, 95% used indication biopsy, 35% used protocol biopsy, 74% used DSA, 20% used C1q positive DSA and none used gene profiling (ENDATS). The reported treatment of subclinical borderline TCMR included iv/PO steroids (20%/13%), increased baseline IS (17%) or no treatment (8%). There was an increased trend for use of Bortezomib from C4D- to C4D+ABMR. For recurrent ABMR, Bortezomib use increased to 39% and Eculizumab use tripled to 21%.

Most centers rely on renal function and f/u bx to ascertain resolution of rejection.

Survey reveals i) diverse management practices for rejection ii) Most rely on indication biopsy for diagnosing TCMR and ABMR, iii) Renal functions and f/u biopsy are used to document resolution of rejection, iii) Urinary cytokines and gene array analysis are rarely used. Standardization of practices for management of TCMR and ABMR is necessary and will give an opportunity to pool data for evaluating clinical outcomes.

CITATION INFORMATION: Sood P., Cherikh W., Toll A., Mehta R., Puttarajappa C., Hariharan S. Results of UNOS Survey on Diagnosis, Treatment and Follow-Up Evaluation of Clinical and Sub-Clinical TCMR and ABMR in Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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