Abstract: SA-PO1155
Significance of Revised Diagnosis for Chronic Active T Cell-Mediated Rejection in 2017 Banff Criteria: Surveillance of 1-Year Screening Biopsy in Kidney Transplantation
Session Information
- Transplantation: Clinical - Rejection, Recurrent Disease, Incompatibility
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Nakagawa, Kaneyasu, Kyushu University, Fukuoka, Japan
- Tsuchimoto, Akihiro, Kyushu University, Fukuoka, Japan
- Ueki, Kenji, Kyushu University, Fukuoka, Japan
- Matsukuma, Yuta, Kyushu University, Fukuoka, Japan
- Okabe, Yasuhiro, Kyushu University, Fukuoka, Japan
- Masutani, Kosuke, Fukuoka University, Fukuoka, Japan
- Nakano, Toshiaki, Kyushu University, Fukuoka, Japan
- Kitazono, Takanari, Kyushu University, Fukuoka, Japan
Background
The diagnosis criteria of chronic active T-cell mediated rejection (TCMR) was revised in Banff 2017 consensus, but the association between the diagnosis of chronic active TCMR at 1-year screening biopsy (SB) and long-term graft prognosis of kidney transplantation has not been reported.
Methods
In this single-center retrospective study, we extracted kidney transplant recipients from 2009 to 2013 who underwent 1-year SB. All the 1-year SB were re-evaluated according to the Banff classification revised in 2017. The primary endpoint was defined as a doubling of creatinine based on values at 1-year after kidney transplantation or graft loss. Death with graft function was censored. The impact of the diagnosis of chronic active TCMR was examined using a Cox regression model.
Results
Among a total of 258 patients who underwent 1-year SB (male of 58% and median age [interquartile range] of 46 [35-56]), 32 patients were re-classified to chronic active TCMR. They were previously diagnosed as normal (n=3), acute TCMR (n=17), and borderline changes (n=12). During the median follow-up period of 6.4 years, 25 patients, including six patients with chronic active TCMR, reached the endpoint. In the multivariate analysis, chronic active TCMR was associated with a higher risk of graft failure compared with no rejection (hazard ratio 2.93; 95% confidence interval, 1.02-8.41: P=0.045).
Conclusion
The chronic active TCMR diagnosis revised in Banff 2017 consensus may be useful for prognostic prediction and may help detect unfortunate prognosis cases in kidney transplant patients who underwent 1-year SB.
Figure. Kaplan-Meier survival curve for death-censored graft failure stratified by the 1-year screening biopsy diagnosis of Banff classification revised in 2017