Impact of Subclinical and Clinical Kidney Allograft Rejection Within 1 Year Posttransplantation Among Compatible Transplant With Steroid Withdrawal Protocol

被引:1
作者
Owoyemi, Itunu [1 ]
Tandukar, Srijan [1 ]
Jorgensen, Dana R. [1 ]
Wu, Christine M. [1 ]
Sood, Puneet [1 ]
Puttarajappa, Chethan [1 ]
Sharma, Akhil [1 ]
Shah, Nirav A. [1 ]
Randhawa, Parmjeet [2 ]
Molinari, Michele [3 ]
Tevar, Amit D. [3 ]
Mehta, Rajil B. [1 ]
Hariharan, Sundaram [1 ]
机构
[1] Thomas E Starzl Transplantat Inst, Dept Med, Pittsburgh, PA USA
[2] Univ Pittsburgh, Dept Pathol, Med Ctr, Pittsburgh, PA USA
[3] Univ Pittsburgh, Dept Surg, Med Ctr, Pittsburgh, PA USA
来源
TRANSPLANTATION DIRECT | 2021年 / 7卷 / 07期
关键词
ANTIBODY-MEDIATED REJECTION; MYCOPHENOLATE-MOFETIL; RENAL-TRANSPLANTATION; UNITED-STATES; END-POINTS; RECIPIENTS; SURVIVAL; CYCLOSPORINE; INFLAMMATION; RISK;
D O I
10.1097/TXD.0000000000001132
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. Early acute kidney rejection remains an important clinical issue. Methods. The current study included 552 recipients who had 1-2 surveillance or indication biopsy within the 1 y posttransplant. We evaluated the impact of type of allograft inflammation on allograft outcome. They were divided into 5 groups: no inflammation (NI: 95), subclinical inflammation (SCI: 244), subclinical T cell-mediated rejection (TCMR) (SC-TCMR: 110), clinical TCMR (C-TCMR: 83), and antibody-mediated rejection (AMR: 20). Estimated glomerular filtration rate (eGFR) over time using linear mixed model, cumulative chronic allograft scores/interstitial fibrosis and tubular atrophy (IFTA) >= 2 at 12 mo, and survival estimates were compared between groups. Results. The common types of rejections were C-TCMR (15%), SC-TCMR (19.9%), and AMR (3.6%) of patients. Eighteen of 20 patients with AMR had mixed rejection with TCMR. Key findings were as follows: (i) posttransplant renal function: eGFR was lower for patients with C-TCMR and AMR (P < 0.0001) compared with NI, SCI, and SC-TCMR groups. There was an increase in delta-creatinine from 3 to 12 mo and cumulative allograft chronicity scores at 12 mo (P < 0.001) according to the type of allograft inflammation. (ii) Allograft histology: the odds of IFTA >= 2 was higher for SC-TCMR (3.7 [1.3-10.4]; P = 0.04) but was not significant for C-TCMR (3.1 [1.0-9.4]; P = 0.26), and AMR (2.5 [0.5-12.8]; P = 0.84) compared with NI group, and (iii) graft loss: C-TCMR accounted for the largest number of graft losses and impending graft losses on long-term follow-up. Graft loss among patient with AMR was numerically higher but was not statistically significant. Conclusions. The type of kidney allograft inflammation predicted posttransplant eGFR, cumulative chronic allograft score/IFTA >= 2 at 12 mo, and graft loss.
引用
收藏
页数:13
相关论文
共 38 条
  • [1] Response to treatment and long-term outcomes in kidney transplant recipients with acute T cell-mediated rejection
    Bouatou, Yassine
    Viglietti, Denis
    Pievani, Daniele
    Louis, Kevin
    Van Huyen, Jean-Paul Duong
    Rabant, Marion
    Aubert, Olivier
    Taupin, Jean-Luc
    Glotz, Denis
    Legendre, Christophe
    Loupy, Alexandre
    Lefaucheur, Carmen
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2019, 19 (07) : 1972 - 1988
  • [2] Post-transplant anti-HLA class II antibodies as risk factor for late kidney allograft failure
    Campos, E. F.
    Tedesco-Silva, H.
    Machado, P. G.
    Franco, M.
    Medina-Pestana, J. O.
    Gerbase-DeLima, M.
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2006, 6 (10) : 2316 - 2320
  • [3] Post-transplant donor specific antibody is associated with poor kidney transplant outcomes only when combined with both T-cell-mediated rejection and non-adherence
    Cherukuri, Aravind
    Mehta, Rajil
    Sharma, Akhil
    Sood, Puneet
    Zeevi, Adriana
    Tevar, Amit D.
    Rothstein, David M.
    Hariharan, Sundaram
    [J]. KIDNEY INTERNATIONAL, 2019, 96 (01) : 202 - 213
  • [4] Long-Term Outcomes after Acute Rejection in Kidney Transplant Recipients: An ANZDATA Analysis
    Clayton, Philip A.
    McDonald, Stephen P.
    Russ, Graeme R.
    Chadban, Steven J.
    [J]. JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2019, 30 (09): : 1697 - 1707
  • [5] Cyclosporine sparing with mycophenolate mofetil, daclizumab and corticosteroids in renal allograft recipients: The CAESAR study
    Ekberg, H.
    Grinyo, J.
    Nashan, B.
    Vantenterghem, Y.
    Vincenti, F.
    Voulgari, A.
    Truman, M.
    Nasymth-Miller, C.
    Rashford, M.
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2007, 7 (03) : 560 - 570
  • [6] Development and clinical validity of a novel blood-based molecular biomarker for subclinical acute rejection following kidney transplant
    Friedewald, John J.
    Kurian, Sunil M.
    Heilman, Raymond L.
    Whisenant, Thomas C.
    Poggio, Emilio D.
    Marsh, Christopher
    Baliga, Prabhakar
    Odim, Jonah
    Brown, Merideth M.
    Ikle, David N.
    Armstrong, Brian D.
    charette, Jane I.
    Brietigam, Susan S.
    Sustento-Reodica, Nedjema
    Zhao, Lihui
    Kandpal, Manoj
    Salomon, Daniel R.
    Abecassis, Michael M.
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2019, 19 (01) : 98 - 109
  • [7] Subclinical rejection in tacrolimus-treated renal transplant recipients
    Gloor, JM
    Cohen, AJ
    Lager, DJ
    Grande, JP
    Fidler, ME
    Velosa, JA
    Larson, TS
    Schwab, TR
    Griffin, MD
    Prieto, M
    Nyberg, SL
    Sterioff, S
    Kremers, WK
    Stegall, MD
    [J]. TRANSPLANTATION, 2002, 73 (12) : 1965 - 1968
  • [8] The Banff 2017 Kidney Meeting Report: Revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials
    Haas, M.
    Loupy, A.
    Lefaucheur, C.
    Roufosse, C.
    Glotz, D.
    Seron, D.
    Nankivell, B. J.
    Halloran, P. F.
    Colvin, R. B.
    Akalin, Enver
    Alachkar, N.
    Bagnasco, S.
    Bouatou, Y.
    Becker, J. U.
    Cornell, L. D.
    van Huyen, J. P. Duong
    Gibson, I. W.
    Kraus, Edward S.
    Mannon, R. B.
    Naesens, M.
    Nickeleit, V.
    Nickerson, P.
    Segev, D. L.
    Singh, H. K.
    Stegall, M.
    Randhawa, P.
    Racusen, L.
    Solez, K.
    Mengel, M.
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2018, 18 (02) : 293 - 307
  • [9] Banff 2013 Meeting Report: Inclusion of C4d-Negative Antibody-Mediated Rejection and Antibody-Associated Arterial Lesions
    Haas, M.
    Sis, B.
    Racusen, L. C.
    Solez, K.
    Glotz, D.
    Colvin, R. B.
    Castro, M. C. R.
    David, D. S. R.
    David-Neto, E.
    Bagnasco, S. M.
    Cendales, L. C.
    Cornell, L. D.
    Demetris, A. J.
    Drachenberg, C. B.
    Farver, C. F.
    Farris, A. B., III
    Gibson, I. W.
    Kraus, E.
    Liapis, H.
    Loupy, A.
    Nickeleit, V.
    Randhawa, P.
    Rodriguez, E. R.
    Rush, D.
    Smith, R. N.
    Tan, C. D.
    Wallace, W. D.
    Mengel, M.
    [J]. AMERICAN JOURNAL OF TRANSPLANTATION, 2014, 14 (02) : 272 - 283
  • [10] Mycophenolate mofetil in renal allograft recipients - A pooled efficacy analysis of three randomized, double-blind, clinical studies in prevention of rejection
    Halloran, P
    Mathew, T
    Tomlanovich, S
    Groth, C
    Hooftman, L
    Barker, C
    [J]. TRANSPLANTATION, 1997, 63 (01) : 39 - 47