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Kidney Week

Abstract: SA-PO1091

Prognostic Implications of Chronic Active T-Cell-Mediated Rejection Diagnosed on Renal Allograft Protocol Biopsies

Session Information

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 - Black274(80.4)225(82.1)24(77.4)25(69.4)0.1807
Donor Type- DBD125(36.7)95(34.7)13(41.9)17(47.2)0.0593
Donor type - DCD65(19.1)49(17.9)5(16.1)11(30.6) 
Donor type - Living151(44.3)130(47.5)13(41.9)8(22.2) 
Gender - Male222(65.1)182(66.4)19(61.3)21(58.3)0.5670
PRA I >5027(8.0)17(6.3)5(16.1)5(13.9)0.0598
PRA II >5039(11.5)27(9.9)6(19.4)6(16.7)0.1752