Abstract
Background. Our aim was to study the impact of clinical acute rejection (CR) and subclinical rejection (SR) on outcomes in kidney transplant recipients treated with rapid steroid withdrawal (RSW). Methods. All patients who received a living or deceased donor kidney transplant and were treated with RSW were included. The primary outcome was death-censored graft survival. Biopsies with Banff borderline changes were included with the rejection groups. Results. 457 kidney transplant recipients treated with RSW were included; 46 (10%) experienced SR, and 36 (7.8%) had CR. Mean HLA mismatch was significantly higher in the CR group. The Banff grade of rejection was higher in the CR group. There was a larger proportion of patients in both rejection groups with the combination of IFTA and persistent inflammation on the follow-up protocol biopsy done at 1 year. The estimated 5-year death-censored graft survival was 81% in SR, 78% in CR, and 97% in the control group (P < .0001). Significant differences were observed in allograft survival between the CR and control group (HR 9.06, 95% CI 3.39–24.2) and between the SR and control group (HR 4.22, 95% CI 1.30–13.7). Conclusion. Both SR and CR are associated with an inferior graft survival in recipients on RSW.
Highlights
The process of allorecognition and acute rejection is an important mechanism of kidney allograft damage resulting in interstitial fibrosis and tubular atrophy (IFTA)
The mean HLA mismatch was significantly higher in the clinical acute rejection (CR) group compared to the no rejection group (3.94 versus 3.33, P < .05), but not for the subclinical rejection (SR) group (3.74)
In this study of kidney transplant recipients treated with a rapid steroid withdrawal protocol clinical acute rejection occurred in 7.8% of patients which is similar to previous studies of early steroid withdrawal [13, 14]
Summary
The process of allorecognition and acute rejection is an important mechanism of kidney allograft damage resulting in interstitial fibrosis and tubular atrophy (IFTA). Most acute rejection is classified as cellular rejection resulting from allorecognition and T-cell-mediated response. Clinical studies have shown that acute rejection, including subclinical acute rejection (SR), is associated with inferior graft survival [5, 10, 11], but all of these studies have been in patients on immunosuppression containing chronic corticosteroid. Our aim was to study the impact of clinical acute rejection (CR) and subclinical rejection (SR) on outcomes in kidney transplant recipients treated with rapid steroid withdrawal (RSW). There was a larger proportion of patients in both rejection groups with the combination of IFTA and persistent inflammation on the follow-up protocol biopsy done at 1 year. Both SR and CR are associated with an inferior graft survival in recipients on RSW
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
