Kidney Week

Abstract: SA-PO1148

Impact of Treatment of Borderline Rejection on Subsequent T Cell-Mediated Rejection in Kidney Transplant Recipients

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

• Kalra, Kartik, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Kartik Kalra,

• Munjal, Ripudaman Singh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Ripudaman Singh Munjal,

• Tandukar, Srijan, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Srijan Tandukar,

• Cashion, Winn, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Winn Cashion,

• Owoyemi, Itunu O., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Itunu O. Owoyemi,

• Sood, Puneet, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Puneet Sood,

• Hariharan, Sundaram, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Sundaram Hariharan,

• Wu, Christine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Christine Wu,

• Mehta, Rajil B., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States

Rajil B. Mehta,

Background

The optimal management of borderline rejection (BR) seen in the early post-transplant period is unclear. Studies have shown that BR is associated with higher Subclinical or Clinical T-Cell Mediated Rejection (TCMR) within 1 year post-transplant. However, the role of steroids in attenuating this risk is unclear. We performed this study to evaluate the impact of treating BR with steroids on subsequent development of TCMR.

Methods

Adult kidney transplant recipients (N=183) with Subclinical or Clinical BR in the first 3 months post-transplant based on Banff 2005 criteria were divided into two groups: (i) No treatment group (N=143), and (ii) Steroid treatment group (N=40). We excluded prior TCMR, Antibody mediated rejection (AMR) and BK virus nephritis. All the patients with BR had their maintenance immunosuppression (MIS) optimized. All patients were induced with thymoglobulin (97%) or basiliximab (3%) and a rapid steroid taper over 5 days per protocol. Standard MIS was with tacrolimus and mycophenolate mofetil. Recipient, donor and transplant variables were similar between the groups. The subsequent development of subclinical and clinical TCMR over the course of the first year was followed.

Results

Refer to Results Table

Conclusion

Treatment of BR in early post-transplant period with steroids was not associated with lower rates of TCMR at 1-year post transplant. However, steroid dose varied in our study from 1 to 3 doses of methyprednisolone. Further studies with uniform dosing of steroids are required to establish definite treatment strategies for BR.

Results