Short-Term Adverse Effects of Early Borderline Changes in Renal Allograft Biopsies.
Department of Medicine and Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
Meeting: 2017 American Transplant Congress
Abstract number: 134
Keywords: Renal function
Session Information
Session Name: Concurrent Session: Kidney: Acute Cellular Rejection
Session Type: Concurrent Session
Date: Sunday, April 30, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 5:06pm-5:18pm
Location: E451b
Background: The short and long-term impact of borderline changes noted on renal allograft biopsies remains unclear.
Methods: A total of 379 patients underwent renal transplantation at our institute from Jan 2013 -Nov 2014. Fifteen were excluded due to death or graft loss within the first 3 months. Patients who underwent protocol biopsies around three months post-transplant were divided into Group I (N=129) with Borderline Rejection per Banff Classification, [t and i score of > 0 and < t2i2] and Group II (N= 71) with normal biopsies (i0,t0,v0,g0). We evaluated differences in renal function in the first 2 years and chronic renal allograft histology score at 1year (ci+ct+cg+cv) as well as the proportion of patients who developed subsequent TCMR during the first year post transplant.
Results: Recipient and Donor Demographics as well as transplant variables were similar between the two groups. We examined the following donor, recipient and transplant variables: KDPI, CIT, WIT, HLA mismatch, DGF and post transplant DSA. Presence of post-transplant DSA was significantly higher in group I, with OR 2.50, (1.01- 6.19) on Multivariate analysis. The following table illustrates post-transplant renal function, 1-year chronicity scores and subsequent TCMR between groups.
| Post-transplant serum creatinine (mg/dl) | Group I: Borderline (n=129) | Group II: Normal (n=71) | P value |
| 3 months | 1.49+0.56 | 1.43+0.49 | 0.43 |
| 1 year | 1.50+0.54 | 1.36+0.39 | 0.056 |
| 2 years | 1.57+0.60 | 1.38+0.45 | 0.035 |
| Chronicity Score (ci+ct+cg+cv) | |||
| 3 months | 1. 73+1.23 | 1.03+0.90 | <0.0001 |
| 1 year | 2.45+1.38 | 1.839+1.20 | 0.02 |
| Occurrence of clinical/subclinical TCMR > Banff IA beyond 3 months | 31/129(24%) | 7/71(10 %) | 0.0147 |
Conclusion: The development of de novo DSA is a risk factor for occurrence of early borderline rejection. Patients with Borderline changes in early renal allograft biopsies had:
i) Statistically significant higher serum creatinine at two years post-transplant
ii) Significantly more chronic histological changes in renal allograft histology at 3 months, with further progression at 1-year and
iii) Higher incidence of subsequent TCMR during the first year post transplant.
CITATION INFORMATION: Bhusal S, Sood P, Cherukuri A, Wu C, Puttarajappa C, Hoffman W, Randhawa P, Tevar A, Shah N, Hariharan S, Mehta R. Short-Term Adverse Effects of Early Borderline Changes in Renal Allograft Biopsies. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Bhusal S, Sood P, Cherukuri A, Wu C, Puttarajappa C, Hoffman W, Randhawa P, Tevar A, Shah N, Hariharan S, Mehta R. Short-Term Adverse Effects of Early Borderline Changes in Renal Allograft Biopsies. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/short-term-adverse-effects-of-early-borderline-changes-in-renal-allograft-biopsies/. Accessed November 21, 2024.« Back to 2017 American Transplant Congress