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Kidney Week

Abstract: FR-PO901

Plasma Cell Infiltrate in Allograft Rejection in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Ou, Shuo-ming, Taipei Veteren General Hospital, Taipei, Taiwan
  • Tarng, Der-Cherng, Taipei Veteran's General Hospital, Taipei, Taiwan
Background

Allograft rejection has always been the chief obstacle to renal outcomes in kidney transplant recipients. We aimed to evaluate the different kidney allograft rejection phenotypes between acute cellular rejection with and without plasma cell infiltrate.

Methods

We conducted a hospital-based study including 1237 kidney transplant recipients between Jan 1, 2002 to Dec 31, 2017 in a tertiary medical center. Of them, we assessed patients who received renal biopsy and biopsy samples showed allograft rejection, which was defined by the renal function deterioration and histopathological lesions. The primary outcome of interest included kidney allograft loss and reinitiation of dialysis, graft histology, the severity of microvascular invasion and tubulitis.

Results

In our study, 1237 patients were included in the main analyses, of whom 293 (23.7%) had acute biopsy-proven rejection. We evaluated distinct patterns of kidney allograft rejection: T cell rejection and antibody mediated rejection with and without plasma infiltrates. Risk of failure to achieve graft function returning to to baseline after 6 month rescue therapy was highest in rejection with plasma cell infiltrate (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.142–3.307; P = 0.0105), followed by antibody rejection without plasma cell infiltrates (HR 1.25), compared with T cell mediated rejection without plasma cell infiltrate.

Conclusion

In our study, we found that allograft rejection with plasma cell infiltrates were associated with poor renal outcomes compared to those without plasma cell infiltrates. Therefore, nephrologists and renal pathologists need to be aware of this entity and arrange more aggressive management to salvage kidney allografts.