Abstract: TH-PO951
The Incidence of Chronic Changes in Protocol Biopsies in Asymptomatic Young Pediatric Renal Transplant Recipients
Session Information
- Live Donor Outcomes and Kidney Transplantation in Pediatric and Ethnic/Racial Groups
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Panombualert, Sunee, Mattel Children's Hospital at UCLA, Los Angeles, California, United States
- Weng, Patricia L., Mattel Children's Hospital at UCLA, Los Angeles, California, United States
- Ettenger, Robert B., Mattel Children's Hospital at UCLA, Los Angeles, California, United States
Background
Previous studies of protocol biopsies (Bx) in stable pediatric kidney transplant (KTx) patients have found a high incidence of interstitial fibrosis (ci) and tubular atrophy (ct), but the effect of recipient age as a continuous variable is unclear.
Methods
We examined the relationships between recipient age (1-10 yrs vs 11-20 yrs) at Bx and the results of protocol Bxs at 6 months, 1 and 2 years in stable pediatric KTx patients from 2005-2016. Bxs were evaluated for subclinical rejection and ci/ct by Banff 2013 criteria.
Results
A total of 506 protocol Bxs were performed. Subclinical rejection was found in 5.5%, 3.8%, and 2.5% at 6 months, 1 and 2 years, respectively of all Bxs and did not differ significantly by time post-Tx or by patient age. In all Bxs, ci ≥ 1 was detected in 15.1% and ct ≥ 1 was found in 16.3% at 6 months. There was no relationship between time after transplant or subclinical rejection and the incidence of ci or ct. However, in the 6 months Bxs, the frequency of ci score was 26.8% in patients 1-10 yrs and only greater than 9.5% those 10-20 yrs (p=0.003). Similarly, ct scores were 28.6% vs 10.3% (p=0.002) at 6 months. By 1 year, ci and ct had increased in both age groups but continued to be significantly higher in patients 1-10 yrs (Table).
Conclusion
Young age as a continuous variable is significantly associated with a higher incidence of chronic tubulointerstitial damage in early protocol biopsies, and this is unrelated to subclinical rejection.
| Histology scores | ci score ≥ 1 | ct score ≥ 1 | ||||
| 6 mo Bx | 1 yr Bx | 2 yr Bx | 6 mo Bx | 1 yr Bx | 2 yr Bx | |
| Age 1-10 | 15(n=56) 26.8% | 23(n=51) 45.1% | 19(n=41) 46.3% | 16(n=56) 28.6% | 24(n=51) 47.1% | 18(n=41) 43.9% |
| Age 11-20 | 11(n=116) 9.5% | 24(n=100) 24% | 17(n=56) 30.4% | 12(n=116) 10.3% | 25(n=100) 25% | 16(n=56) 28.6% |
| p-value | 0.003 | 0.008 | 0.107 | 0.002 | 0.006 | 0.118 |