Abstract: SA-PO1091
Prognostic Implications of Chronic Active T-Cell-Mediated Rejection Diagnosed on Renal Allograft Protocol Biopsies
Session Information
- Transplantation: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Kalaria, Arjun Lalit, UPMC, Pittsburgh, Pennsylvania, United States
- Karimi, Hussain Abde Ali, UPMC, Pittsburgh, Pennsylvania, United States
- Pittappilly, Matthew, UPMC, Pittsburgh, Pennsylvania, United States
- Cruz Peralta, Massiel Penelope, UPMC, Pittsburgh, Pennsylvania, United States
- Hariharan, Sundaram, UPMC, Pittsburgh, Pennsylvania, United States
- Puttarajappa, Chethan M., UPMC, Pittsburgh, Pennsylvania, United States
- Sood, Puneet, UPMC, Pittsburgh, Pennsylvania, United States
- Sharma, Akhil, UPMC, Pittsburgh, Pennsylvania, United States
- Mehta, Rajil B., UPMC, Pittsburgh, Pennsylvania, United States
Background
Banff 2017 introduced Chronic Active TCMR(CA-TCMR) into the classification of rejection. However, the significance of this finding on early protocol biopsies has not been explored.
Methods
We identified a cohort of patients with serial protocol biopsies performed between Oct 2018-Jan 2022. Biopsies were done at 3- and 12- months. We chose the protocol biopsy closest to the 1-year time point. We included both living and deceased donor kidney transplants. De-novo and repeat kidney transplants were included. We excluded biopsies with borderline rejection, antibody mediated rejection or BK virus nephritis. Biopsies that qualified for TCMR were further divided into acute TCMR(n=31) and CA-TCMR(n=36). Biopsies with no major abnormalities (NMA) were used as control. The maximum follow up period was 5.5 y with a median follow up of 3.5 y.
All patients received induction therapy with anti-thymocyte globulin and maintenance immunosuppression with tacrolimus and MMF. Patients with cPRA>90% also received maintenance steroids.
Results
See below
Conclusion
CA-TCMR is common in early protocol biopsies and is more common in deceased donor kidney transplants. Allograft survival was lower in biopsies with CA-TCMR. Finding of CA-TCMR on early protocol biopsies prognosticates long term allograft outcome.
Demographics
| ALL (n=341) | NMA (n=274) | A-TCMR (n=31) | CA-TCMR (n=36) | p-value | |
| Age Median (Q range) | 56 (42-66) | 55(41-65) | 58(45-70) | 59.5(46.5-68.5) | 0.1808 |
| Race - Black | 274(80.4) | 225(82.1) | 24(77.4) | 25(69.4) | 0.1807 |
| Donor Type- DBD | 125(36.7) | 95(34.7) | 13(41.9) | 17(47.2) | 0.0593 |
| Donor type - DCD | 65(19.1) | 49(17.9) | 5(16.1) | 11(30.6) | |
| Donor type - Living | 151(44.3) | 130(47.5) | 13(41.9) | 8(22.2) | |
| Gender - Male | 222(65.1) | 182(66.4) | 19(61.3) | 21(58.3) | 0.5670 |
| PRA I >50 | 27(8.0) | 17(6.3) | 5(16.1) | 5(13.9) | 0.0598 |
| PRA II >50 | 39(11.5) | 27(9.9) | 6(19.4) | 6(16.7) | 0.1752 |