Therapeutic Response of Late Clinical Cell Mediated Rejection is Modeled by Chronicity Changes
1Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, 2Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, PA
Meeting: 2021 American Transplant Congress
Abstract number: 240
Keywords: Glucocortocoids, Graft function, Rejection
Topic: Clinical Science » Kidney » Kidney: Acute Cellular Rejection
Session Name: Kidney: Acute Cellular Rejection
Session Type: Rapid Fire Oral Abstract
Date: Monday, June 7, 2021
Session Time: 4:30pm-5:30pm
Presentation Time: 5:05pm-5:10pm
*Purpose: Although there is a tendency to treat late clinical TCMR, the responsiveness to steroids is unclear.
*Methods: Among kidney transplant recipients, transplanted between Jan 2013 and December 2017, we followed clinical rejections (beyond 6months) in a cohort of patients who had undergone a 3 month surveillance biopsy and no episodes of clinical rejection. Of the 62 patients who had a late rejection, 45 had pure TCMR (Banff IA/IB in severity). The majority of the patients (>95%) were induced with thymoglobulin at the time of transplant. Those who were diagnosed to have TCMR were treated with steroids 250 mg iv for a total of 3 doses. We compared baseline GFR, GFR at time of biopsy and the best GFR within 3 months of rejection treatment in the TCMR group. Based on the GFR response, the patients were divided into those that continued to have worsening GFR post treatment (n=12) and those where GFR stabilized or improved post treatment (n=33). Based on the binary variable of response to treatment, a multivariable logistic regression was performed taking into consideration recipient age, sex, race, sensitization, DGF and DSA. We used the total i score to account for inflammation in the scarred areas.
*Results: The median change in GFR among all clinical TCMR was 4 ml/min (IQR -0.5 to 7.8). Multivariable analysis revealed IFTA score>2 (p=0.017; OR 7.6, CI 1.4-40) was associated with lack of improvement post treatment.
*Conclusions: 1. Therapeutic response of pure late T cell mediated rejection to steroids is modest at best, with a median change in GFR of only 4 ml/min. 2. IFTA score of greater than 2 was associated with a poor therapeutic response in pure TCMR. 3. Factors impacting response to late TCMR should be analyzed in larger studies given poor responsiveness to treatment.
To cite this abstract in AMA style:Melgarejo I, Visnawathan V, Sharma A, Sood P, Puttarajappa C, Wu C, Shah N, Molinari M, Hariharan S, Mehta R. Therapeutic Response of Late Clinical Cell Mediated Rejection is Modeled by Chronicity Changes [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/therapeutic-response-of-late-clinical-cell-mediated-rejection-is-modeled-by-chronicity-changes/. Accessed March 26, 2023.
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