Natural History, Risk Factors, and Impact of Subclinical Rejection in Kidney Transplantation

Abstract

Histologic evidence of acute rejection in the absence of clinical suspicion resulted in significant tubulointerstitial damage to transplanted kidneys and contributed to CAN.

Protocol Transplant Biopsies

“…More recent studies have reported on early subclinical rejection in patients who received tacrolimus, either with (10,11,13,21,22) or without (7) MMF. Jurewicz (7) reported a prevalence of subclinical rejection (that included "borderline") of 18% at 3 mo in patients who received kidneys from deceased donors and were treated with tacrolimus, azathioprine, and prednisone.…”

“…Jurewicz (7) reported a prevalence of subclinical rejection (that included "borderline") of 18% at 3 mo in patients who received kidneys from deceased donors and were treated with tacrolimus, azathioprine, and prednisone. Nankivell et al (22) reported a prevalence of subclinical rejection (including borderline) of Ͼ50% at 1 mo that was virtually abolished at 3, 6, and 12 mo in patients who were on tacrolimus and MMF. Gloor et al (11) reported a similar prevalence of subclinical rejection of only 2.6% at 3 mo in patients who were on tacrolimus and MMF.…”

“…In some studies, the use of cyclosporine microemulsion (21,22) and MMF (14,21,22) reduced the prevalence of subclinical rejection. However, this was not observed in all studies (20).…”

Renal Allograft Fibrosis: Biology and Therapeutic Targets

“…Thus, early inflammation detected in protocol biopsies predicts progression of renal fibrosis and shorter renal allograft survival (248)(249)(250).…”

Subclinical rejection and sirolimus associated edema in renal allograft recipients

“…Such findings are common within the first 3 months of the transplant, occurring in approximately 30% of patients with stable allograft function who are receiving a cyclosporin-based regimen [13]. Although the clinical significance of subclinical rejection remains to be determined, some authors [14] suggested that it precedes the development of chronic allograft nephropathy. Thus, our two cases fit the definitions of both subclinical rejection and SRL-associated edema.…”