Abstract: SA-OR65
The Impact of Subclinical T Cell-Mediated Rejection on Subsequent Rejections and Allograft Survival in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis
Session Information
- Kidney Transplantation: New Translational Insights
November 04, 2023 | Location: Room 115, Pennsylvania Convention Center
Abstract Time: 05:33 PM - 05:42 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Yamada, Takayuki, UPMC, Pittsburgh, Pennsylvania, United States
- Obata, Shota, Mount Sinai Beth Israel Hospital, New York, New York, United States
- Kalaria, Arjun Lalit, UPMC, Pittsburgh, Pennsylvania, United States
- Molinari, Michele, UPMC, Pittsburgh, Pennsylvania, United States
- Mehta, Rajil B., UPMC, Pittsburgh, Pennsylvania, United States
Background
Subclinical T cell mediated rejection (SC-TCMR) refers to the presence of histological features of acute rejection on renal biopsy without a decline in renal function. Although single centers have reported an adverse impact of SC-TCMR on allograft outcomes, there is a dearth of data on this subject.
Methods
We conducted a comprehensive systematic search on PubMed, EMBASE, and the Cochrane Library from inception to May 16th, 2023. We included studies involving adult patients (>18 years old) who underwent kidney transplants and exhibited SC-TCMR detected through surveillance biopsy. Studies involving non-human subjects or lacking available data were excluded. The primary outcome measure was death-censored allograft loss, while the secondary outcome was subsequent rejection. A random-effects model was used to determine the risk.
Results
A total of nine studies were selected, encompassing a pooled population of 2,423 patients. SC-TCMR was found to be associated with an increased risk of death-censored graft loss (Risk ratio (RR) 1.78, 95% confidence interval (CI) 1.03 to 3.07), although heterogeneity was high (I2 69%). Furthermore, SC-TCMR was also associated with a higher risk of subsequent rejection (RR 2.66, 95% CI 1.96 to 3.61, I2 0%).
Conclusion
SC-TCMR diagnosed through surveillance biopsy was found to be linked with an elevated risk of subsequent rejection and death-censored graft loss.
Forest plot of the association between Subclinical T cell mediated rejection (SC-TCMR) and death-censored graft loss
Forest plot of the association between Subclinical T cell mediated rejection (SC-TCMR) and subsequent rejection