BACKGROUND: We investigated the effect of clinical and subclinical T cell-mediated rejection (C-TCMR and SC-TCMR) on allograft histology, function, and progression. METHODS: Adult kidney recipients with 2 protocol biopsies were divided into No-TCMR on biopsies (n = 104), SC-TCMR (n = 56), and C-TCMR (n = 32) in at least 1 biopsy. Chronicity (ci + ct + cg + cv) scores, renal function, and the burden of renal disease measured by area under the curve (serum creatinine, mg mo/dL) were compared. RESULTS: Baseline characteristics were similar except for mean donor age and Kidney Donor Profile index scores. Patients with C-TCMR had higher mean serum creatinine, lower mean estimated glomerular filtration rate, and higher area under the curve with 95% confidence interval (75.2 [67.7-82.7]) as opposed to patients with SC-TCMR and No-TCMR (58.3 [53.6-62.9], 65.1 [58.8-71.5]), P = 0.0004. Chronicity scores were higher at 3 months in C-TCMR (2.30 ± 1.58) compared with SC-TCMR (2.02 ± 1.42) and No-TCMR (1.31 ± 1.18), P = 0.0001 and also at 12 months. At last follow-up, 18.8% patients with C-TCMR had ≥50% decline in estimated glomerular filtration rate from 3 months compared with 7% and 1% among No-TCMR and SC-TCMR groups (P = 0.038). Multivariate analyses revealed higher odds of Δ-creatinine ≥ 0.5 mg/dL from 3 months to last follow-up for C-TCMR (3.39 [95% confidence interval, 1.25-9.20]) versus No-TCMR (P = 0.016). CONCLUSIONS: Kidney transplant recipients with C-/SC-TCMR have heightened early allograft chronicity and worse renal function compared with those with No-TCMR. Progressive renal dysfunction was noted among patients with C-TCMR as opposed to SC-TCMR and No-TCMR.
BACKGROUND: We investigated the effect of clinical and subclinical T cell-mediated rejection (C-TCMR and SC-TCMR) on allograft histology, function, and progression. METHODS: Adult kidney recipients with 2 protocol biopsies were divided into No-TCMR on biopsies (n = 104), SC-TCMR (n = 56), and C-TCMR (n = 32) in at least 1 biopsy. Chronicity (ci + ct + cg + cv) scores, renal function, and the burden of renal disease measured by area under the curve (serum creatinine, mg mo/dL) were compared. RESULTS: Baseline characteristics were similar except for mean donor age and Kidney Donor Profile index scores. Patients with C-TCMR had higher mean serum creatinine, lower mean estimated glomerular filtration rate, and higher area under the curve with 95% confidence interval (75.2 [67.7-82.7]) as opposed to patients with SC-TCMR and No-TCMR (58.3 [53.6-62.9], 65.1 [58.8-71.5]), P = 0.0004. Chronicity scores were higher at 3 months in C-TCMR (2.30 ± 1.58) compared with SC-TCMR (2.02 ± 1.42) and No-TCMR (1.31 ± 1.18), P = 0.0001 and also at 12 months. At last follow-up, 18.8% patients with C-TCMR had ≥50% decline in estimated glomerular filtration rate from 3 months compared with 7% and 1% among No-TCMR and SC-TCMR groups (P = 0.038). Multivariate analyses revealed higher odds of Δ-creatinine ≥ 0.5 mg/dL from 3 months to last follow-up for C-TCMR (3.39 [95% confidence interval, 1.25-9.20]) versus No-TCMR (P = 0.016). CONCLUSIONS: Kidney transplant recipients with C-/SC-TCMR have heightened early allograft chronicity and worse renal function compared with those with No-TCMR. Progressive renal dysfunction was noted among patients with C-TCMR as opposed to SC-TCMR and No-TCMR.
Authors: Chethan M Puttarajappa; Rajil B Mehta; Mark S Roberts; Kenneth J Smith; Sundaram Hariharan Journal: Am J Transplant Date: 2020-07-15 Impact factor: 8.086
Authors: Christie Rampersad; Robert Balshaw; Ian W Gibson; Julie Ho; Jamie Shaw; Martin Karpinski; Aviva Goldberg; Patricia Birk; David N Rush; Peter W Nickerson; Chris Wiebe Journal: Am J Transplant Date: 2021-11-24 Impact factor: 9.369
Authors: Michael E Seifert; Gaurav Agarwal; Miriam Bernard; Ellen Kasik; S Sikandar Raza; Huma Fatima; Robert S Gaston; Vera Hauptfeld-Dolejsek; Bruce A Julian; Clifton E Kew; Vineeta Kumar; Shikha Mehta; Song Ong; Frida Rosenblum; Graham Towns; Roslyn B Mannon Journal: Transplant Direct Date: 2021-01-26
Authors: Scott Davis; Christopher Wiebe; Kristen Campbell; Cheri Anobile; Michael Aubrey; Erik Stites; Monica Grafals; Elizabeth Pomfret; Peter Nickerson; James E Cooper Journal: Am J Transplant Date: 2020-10-11 Impact factor: 8.086
Authors: Itunu Owoyemi; Srijan Tandukar; Dana R Jorgensen; Christine M Wu; Puneet Sood; Chethan Puttarajappa; Akhil Sharma; Nirav A Shah; Parmjeet Randhawa; Michele Molinari; Amit D Tevar; Rajil B Mehta; Sundaram Hariharan Journal: Transplant Direct Date: 2021-06-08
Authors: Chris Wiebe; David N Rush; Ian W Gibson; Denise Pochinco; Patricia E Birk; Aviva Goldberg; Tom Blydt-Hansen; Martin Karpinski; Jamie Shaw; Julie Ho; Peter W Nickerson Journal: Am J Transplant Date: 2020-04-09 Impact factor: 8.086