1. Acute Rejection Clinically Defined Phenotypes Correlate With Long-term Renal Allograft Survival
- Author
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Amit Govil, David P. Witte, Jill C. Krisl, Michael Cardi, G. Mogilishetty, Tayyab S. Diwan, Bassam G. Abu Jawdeh, E. Steve Woodle, Alin Girnita, Adele Rike Shield, and Rita R. Alloway
- Subjects
Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Databases, Factual ,Biopsy ,Urology ,Renal function ,Complement C4b ,Living Donors ,medicine ,Humans ,Prospective Studies ,Renal Insufficiency ,Prospective cohort study ,Kidney transplantation ,Transplantation ,medicine.diagnostic_test ,business.industry ,Graft Survival ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Phenotype ,Peptide Fragments ,Treatment Outcome ,Etiology ,Renal allograft ,Female ,Graft survival ,business ,Follow-Up Studies ,Glomerular Filtration Rate - Abstract
Background Classification of acute rejection (AR) based on etiology and timing may provide a means for enhancing therapeutic results and allograft survival. This study evaluated graft and patient survival after the first AR episodes among kidney transplant recipients with an early or late antibody-mediated rejection (AMR), acute cellular rejection (ACR) or mixed AR (MAR). Methods A prospective institutional review board-approved database was queried to identify biopsy-proven first AR episodes occurring from January 2005 to October 2012. The ACR was defined by Banff criteria; borderline AR was excluded. The AMR was defined as 3 of 4 criteria: renal dysfunction, donor specific antibody, C4d positivity on biopsy, and histological changes. The MAR met criteria for both ACR and AMR. Early AR occurred within six months post-transplant. AR episodes were then assigned to 1 of the 6 categories--early AMR, early ACR, early MAR, late AMR, late ACR, and late MAR. Results One hundred eighty-two kidney transplant recipients identified with a first AR episode. Mean follow-up was 773 days (± 715 days). No difference was observed in patient survival. Death-censored graft survival was 84%. Death-censored graft loss was higher with late versus early AMR (P = 0.01) and late versus early ACR (P = 0.03), but not late versus early MAR (P = 0.3). Conclusions The AR type demonstrated a hierarchy for graft survival with ACR better than MAR better than AMR, which persisted for both early and late AR. Improvement in long-term results of AR may require development of specific treatment for individual AR types.
- Published
- 2015