Effect of steroid pulse therapy on post‐transplant immunoglobulin A nephropathy

Matsukuma, Yuta; Masutani, Kosuke; Tsuchimoto, Akihiro; Okabe, Yoshinobu; Nakamura, Masafumi; Kitazono, Takanari; Tsuruya, Kazuhiko

doi:10.1111/nep.13272

Cited by 8 publications

(2 citation statements)

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“…Using treatment response as an indicator of accurate diagnosis should be done with caution because clinicians try various ways to improve clinical outcomes such as immunosuppressant adjustment, hydration, and correction of other possible factors that can suppress the kidney function. In addition, T-cell reaction and B-cell reaction are not separate events, and steroid treatment can affect the kidney function through multiple mechanisms 22,23 .…”

Section: Discussionmentioning

confidence: 99%

Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment 

Kwon

Kim

et al. 2020

Preprint

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Over the last two decades, the focus of studies on graft survival (GS) after kidney transplantation (KT) has largely shifted from T-cell mediated rejection (TCMR) to antibody-mediated rejection (ABMR). However, there are still cases of pure acute TCMR in histological reports, even after a long time following transplant. We thus evaluated the impact of pure TCMR on GS according to treatment response. We also performed molecular diagnosis using a molecular microscope diagnostic system (MMDx) to determine the accuracy of the histologic diagnosis of pure TCMR. A total of 63 patients were included in our study and divided into non-responders (N = 22) and responders (N = 44) according to their response to rejection treatment. Molecular diagnosis and histologic diagnosis were conducted simultaneously on a separate group of 23 patients. The non-responders had a significantly longer duration between treatment and recurrent rejection than did the responders (24 vs. 11 months; P < 0.01). The cumulative incidence of recurrent rejection after treatment was significantly higher in the non-responders as well (64% vs. 29%; P < 0.01). Non-response to rejection treatment was significantly associated with the following factors: GFR at biopsy, ΔGFR (baseline GFR – GFR at biopsy), TCMR within one year, t score, and IF/TA score. We also found that non-responder vs. responder (HR = 3.31; P = 0.04) and lower GFR at biopsy per 10 mL/min/1.73m2 (HR = 0.56; P = 0.03) were independent risk factors of graft failure. The responders had a significantly superior overall GS rate compared with the non-responders (P < 0.01). Molecular assessment using MMDx showed a good correlation with histologic diagnosis in ABMR, but not in TCMR. Solitary TCMR was a significant risk factor of graft failure in patients who did not respond to rejection treatment. Molecular assessment using MMDx did not show a good correlation with histologic diagnosis in TCMR, suggesting that acute pure TCMR at one year after transplant in histologic reports should be interpreted with caution.

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Section: Discussionmentioning

confidence: 99%

Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment 

Kwon

Kim

et al. 2020

Preprint

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Section: Plos Onementioning

confidence: 99%

Pure T-cell mediated rejection following kidney transplant according to response to treatment

et al. 2021

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The focus of studies on kidney transplantation (KT) has largely shifted from T-cell mediated rejection (TCMR) to antibody-mediated rejection (ABMR). However, there are still cases of pure acute TCMR in histological reports, even after a long time following transplant. We thus evaluated the impact of pure TCMR on graft survival (GS) according to treatment response. We also performed molecular diagnosis using a molecular microscope diagnostic system on a separate group of 23 patients. A total of 63 patients were divided into non-responders (N = 22) and responders (N = 44). Non-response to rejection treatment was significantly associated with the following factors: glomerular filtration rate (GFR) at biopsy, ΔGFR, TCMR within one year, t score, and IF/TA score. We also found that non-responder vs. responder (OR = 3.31; P = 0.036) and lower GFR at biopsy (OR = 0.56; P = 0.026) were independent risk factors of graft failure. The responders had a significantly superior overall GS rate compared with the non-responders (P = 0.004). Molecular assessment showed a good correlation with histologic diagnosis in ABMR, but not in TCMR. Solitary TCMR was a significant risk factor of graft failure in patients who did not respond to rejection treatment.

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Recurrent Disease Challenges in Pediatric Kidney Transplantation

Harshman

Bartosh

2021

Challenges in Pediatric Kidney Transplantation

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Effect of steroid pulse therapy on post‐transplant immunoglobulin A nephropathy

Abstract: Steroid pulse therapy for post-transplant immunoglobulin A nephropathy effectively reduces proteinuria over 2 years. However, comparison of steroid pulse therapy and other regimens with a high-quality design is required.

Cited by 8 publications

References 30 publications

Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment

Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment

Pure T-cell mediated rejection following kidney transplant according to response to treatment

Recurrent Disease Challenges in Pediatric Kidney Transplantation

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Effect of steroid pulse therapy on post‐transplant immunoglobulin A nephropathy

Abstract: Steroid pulse therapy for post-transplant immunoglobulin A nephropathy effectively reduces proteinuria over 2 years. However, comparison of steroid pulse therapy and other regimens with a high-quality design is required.

Cited by 8 publications

References 30 publications

Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment&nbsp;

Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment&nbsp;

Pure T-cell mediated rejection following kidney transplant according to response to treatment

Recurrent Disease Challenges in Pediatric Kidney Transplantation

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Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment

Pure T-cell Mediated Rejection Following Kidney Transplant According to Response to Treatment