Renal Allograft Rejection With Normal Renal Function in Simultaneous Kidney/Pancreas Recipients

Shapiro, Ron; Ml, Jordan; Vp, Scantlebury; Ca, Vivas; Jain, Ashok; McCauley, Jerry; Mf, Egidi; Randhawa, Parmjeet; Chakrabarti, Pradip; Rj, Corry

doi:10.1097/00007890-200002150-00024

Cited by 37 publications

(16 citation statements)

References 8 publications

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“…We have noted similar findings in a small number of simultaneous kidney/ pancreas (SPK) recipients who underwent renal allograft biopsy, despite having stable and normal renal function, because of a rising serum lipase level (i.e. suspected pancreatic rejection) (12). This demonstration of unsuspected tubulitis raised a concern that we have been systematically underestimating the incidence of acute rejection in our patients.…”

Section: Introductionsupporting

confidence: 71%

An Analysis of Early Renal Transplant Protocol Biopsies – the High Incidence of Subclinical Tubulitis

Shapiro

Randhawa

Jordan

et al. 2001

American Journal of Transplantation

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To investigate the possibility that we have been underestimating the true incidence of acute rejection, we began to perform protocol biopsies after kidney transplantation. This analysis looks at the one-week biopsies. Between March 1 and October 1, 1999, 100 adult patients undergoing cadaveric kidney or kidney/pancreas transplantation, or living donor kidney transplantation, underwent 277 biopsies. We focused on the subset of biopsies in patients without delayed graft function (DGF) and with stable or improving renal function, who underwent a biopsy 8.2 ∫ 2.6 d (range 3-18 d) after transplantation (n Ω 28). Six (21%) patients with no DGF and with stable or improving renal function had borderline histopathology, and 7 (25%) had acute tubulitis on the one-week biopsy. Of the 277 kidney biopsies, there was one (0.4%) serious hemorrhagic complication, in a patient receiving low molecular weight heparin; she ultimately recovered and has normal renal function. Her biopsy showed Banff 1B tubulitis. In patients with stable or improving renal allograft function early after transplantation, subclinical tubulitis may be present in a substantial number of patients. This suggests that the true incidence of rejection may be higher than is clinically appreciated.

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Section: Introductionsupporting

confidence: 71%

An Analysis of Early Renal Transplant Protocol Biopsies – the High Incidence of Subclinical Tubulitis

Shapiro

Randhawa

Jordan

et al. 2001

American Journal of Transplantation

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“…It is plausible that acute rejection is under-reported by the staff who enter these data for the OTPN and might have limited medical knowledge. For the DDS, acute rejection was defined by clinical diagnosis, regardless of whether antirejection treatment was given, and only a small percentage of patients underwent protocol biopsy (23)(24)(25). We did not require biopsy for the definition of acute rejection in the DDS, because the OPTN fields related to acute rejection that were used for this study also do not specify biopsy findings.…”

Section: Discussionmentioning

confidence: 99%

Validating Early Post–Transplant Outcomes Reported for Recipients of Deceased Donor Kidney Transplants

Potluri

Parikh

Hall

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Data reported to the Organ Procurement and Transplantation Network (OPTN) are used in kidney transplant research, policy development, and assessment of center quality, but the accuracy of early post-transplant outcome measures is unknown.Design, setting, participants, & measurements The Deceased Donor Study (DDS) is a prospective cohort study at five transplant centers. Research coordinators manually abstracted data from electronic records for 557 adults who underwent deceased donor kidney transplantation between April of 2010 and November of 2013. We compared the post-transplant outcomes of delayed graft function (DGF; defined as dialysis in the first posttransplant week), acute rejection, and post-transplant serum creatinine reported to the OPTN with data collected for the DDS.Results Median kidney donor risk index was 1.22 (interquartile range [IQR], 0.97-1.53). Median recipient age was 55 (IQR, 46-63) years old, 63% were men, and 47% were black; 93% had received dialysis before transplant. Using DDS data as the gold standard, we found that pretransplant dialysis was not reported to the OPTN in only 11 (2%) instances. DGF in OPTN data had a sensitivity of 89% (95% confidence interval [95% CI], 84% to 93%) and specificity of 98% (95% CI, 96% to 99%). Surprisingly, the OPTN data accurately identified acute allograft rejection in only 20 of 47 instances (n=488; sensitivity of 43%; 95% CI, 17% to 73%). Across participating centers, sensitivity of acute rejection varied widely from 23% to 100%, whereas specificity was uniformly high (92%-100%). Six-month serum creatinine values in DDS and OPTN data had high concordance (n=490; Lin concordance correlation =0.90; 95% CI, 0.88 to 0.92).Conclusions OPTN outcomes for recipients of deceased donor kidney transplants have high validity for DGF and 6-month allograft function but lack sensitivity in detecting rejection. Future studies using OPTN data may consider focusing on allograft function at 6 months as a useful outcome.

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“…Klassen et al have reported a 27% incidence of isolated pancreas rejection in SPK (40), however, it is unclear how many of the patients in this study actually underwent simultaneous kidney and pancreas biopsies. Indeed, whether dissynchronous rejection even exists has been questioned by Shapiro et al who performed kidney biopsies in SPK patients with normal serum creatinine in the presence of clinically suspected pancreas rejection (elevated serum lipase) (41). All kidney biopsies had histologic evidence of rejection, and serum lipase improved in response to bolus steroid therapy.…”

Section: Discussionmentioning

confidence: 99%

Effect of Ethnicity on Outcome of Simultaneous Pancreas and Kidney Transplantation

Rogers

Baliga

Chavin

et al. 2003

American Journal of Transplantation

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The influence of ethnicity on outcome of simultaneous pancreas-kidney transplantation (SPK) is poorly defined. After excluding technical failures, we retrospectively reviewed 96 consecutive SPKs (63 Caucasians [C], 33 African-Americans [AA]). All patients received antibody induction, tacrolimus, mycophenolate mofetil, and steroids. One-, 3-, and 5-year actuarial patient survival was similar between C (98%, 95%, 87%) and AA (90%, 90%, 81%), p = = NS. One-, 3-, and 5-year kidney graft survival was similar between C (98%, 86%, 81%) and AA (85%, 85%, 78%), p = = NS. One-, 3-, and 5-year pancreas graft survival was significantly worse in AA (71%, 68%, 46%) than in C (90%, 85%, 81%), p = = 0.008. The cumulative incidence of kidney and pancreas acute rejection (AR) was higher in AA compared with C. Distribution of kidney and pancreas rejection grade was similar between C and AA. AA experienced more pancreas graft losses from early death with functioning graft, AR, and late chronic rejection. The higher incidence of AR and resistance to currently employed induction, maintenance, and antirejection immunosuppression therapies in AA may account for their inferior pancreas graft survival. More aggressive immunosuppression strategies may improve pancreas graft survival in AA but may be associated with increased morbidity and mortality. Further study is warranted.

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Renal Allograft Rejection With Normal Renal Function in Simultaneous Kidney/Pancreas Recipients

Cited by 37 publications

References 8 publications

An Analysis of Early Renal Transplant Protocol Biopsies – the High Incidence of Subclinical Tubulitis

An Analysis of Early Renal Transplant Protocol Biopsies – the High Incidence of Subclinical Tubulitis

Validating Early Post–Transplant Outcomes Reported for Recipients of Deceased Donor Kidney Transplants

Effect of Ethnicity on Outcome of Simultaneous Pancreas and Kidney Transplantation

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