Date: Sunday, April 30, 2017
Session Name: Concurrent Session: Kidney: Acute Cellular Rejection
Session Time: 4:30pm-6:00pm
Presentation Time: 5:06pm-5:18pm
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|
|Chronicity Score (ci+ct+cg+cv)|
|3 months||1. 73+1.23||1.03+0.90||<0.0001|
|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 September 22, 2020.
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