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Kidney Allograft Survival After Acute Rejection, the Value of Follow‐Up Biopsies
Author(s) -
El Ters M.,
Grande J. P.,
Keddis M. T.,
Rodrigo E.,
Chopra B.,
Dean P. G.,
Stegall M. D.,
Cosio F. G.
Publication year - 2013
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.12370
Subject(s) - medicine , histology , fibrosis , alloimmunity , biopsy , kidney , gastroenterology , kidney transplantation , inflammation , transplantation , urology , pathology
Kidney allografts are frequently lost due to alloimmunity. Still, the impact of early acute rejection (AR) on long‐term graft survival is debated. We examined this relationship focusing on graft histology post‐AR and assessing specific causes of graft loss. Included are 797 recipients without anti‐donor antibodies (DSA) at transplant who had 1 year protocol biopsies. 15.2% of recipients had AR diagnosed by protocol or clinical biopsies. Compared to no‐AR, all histologic types of AR led to abnormal histology in 1 and 2 years protocol biopsies, including more fibrosis + inflammation (6.3% vs. 21.9%), moderate/severe fibrosis (7.7% vs. 13.5%) and transplant glomerulopathy (1.4% vs. 8.3%, all p < 0.0001). AR were associated with reduced graft survival (HR = 3.07 (1.92–4.94), p < 0.0001). However, only those AR episodes followed by abnormal histology led to reduced graft survival. Early AR related to more late alloimmune‐mediated graft losses, particularly transplant glomerulopathy (31% of losses). Related to this outcome, recipients with AR were more likely to have new DSA class II 1 year posttransplant (no‐AR, 11.1%; AR, 21.2%, p = 0.039). In DSA negative recipients, early AR often leads to persistent graft inflammation and increases the risk of new DSA II production. Both of these post‐AR events are associated with increased risk of graft loss.