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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

Category: Transplantation

  • 2102 Transplantation: Clinical


  • 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

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.


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.


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%).


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