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Kidney Week

Abstract: FR-PO882

Treatment of Biopsy-Proven Borderline Rejection in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Dale, Leigh-Anne, Columbia University Medical Center, New York, New York, United States
  • Tsapepas, Demetra, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York, United States
  • Husain, Syed Ali, Columbia University Medical Center, New York, New York, United States
  • Mohan, Sumit, Columbia University, New York, New York, United States

Group or Team Name

  • Columbia University Renal Epidemiology [CURE]
Background

Borderline cellular rejections are now the most common type of rejection found after kidney transplantation. Most centers either treat borderline rejection episodes with a pulse of high dose corticosteroids or do not provide any additional immunosuppression.

Methods

We identified 161 consecutive patients (50.6 ± 14.8 yrs, 62% male) who had a borderline rejection on allograft biopsy with no prior evidence of biopsy proven acute rejection between 2008 – 2015 at our center. While the majority of patients received our protocol of high dose corticosteroids, we identified 29 patients who did not receive any additional immunosuppression. We compared improvement in renal function over 4 weeks after the rejection episode for those who were treated versus those who were not.

Results

Recipients who were treated were significantly younger (55.7±12.7 vs 49.4±15.1 years p=0.03) than recipients who were not treated but were similar with respect to gender distribution, time from transplant to biopsy (347.7±486 vs 264.1±481.9 days, p=ns), and the creatinine at the time of biopsy (2.29±0.95 vs 2.57±1.48 mg/dL, p=ns). There was no difference in the decrease in serum creatinine at 4 weeks (0.31±0.55 not treated vs 0.59±1.28 mg/dL treated, p=ns) and 90 days (0.48±0.2 not treated vs 0.64±1.1 mg/dL not treated) following the biopsy between the two groups. While there were a higher number of graft failures among patients who were not treated (28.1% vs 18.2%, p=ns), this difference was not significant. [figure1]

Conclusion

The treatment of isolated borderline rejections with high dose pulse steroids did not improve short term outcomes in this single-center retrospective study. The higher rate of graft failure in the nontreated arm is however concerning and more studies are needed to understand the optimal management strategy for biopsy proven borderline rejections.

Time from biopsy to graft failure