Response to Treatment for Chronic-active T Cell–mediated Rejection in Kidney Transplantation: A Report of 3 Cases

Noguchi, Hiroshi; Nakagawa, Kaneyasu; Ueki, Katsuji; Tsuchimoto, Akihiro; Kaku, Keizo; Okabe, Yoshinobu; Nakamura, Masafumi

doi:10.1097/txd.0000000000001079

Cited by 5 publications

(8 citation statements)

References 11 publications

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“…According to clinical case reports combining doses of maintenance oral immunosuppressive agents such as Tac, MMF, MP and EVR with ATG administration together with steroid pulse therapy may give promiscuous results. In the outcome of the treatment in some cases part of lesions characteristic for CA TCMR subsided and in none of 3 patients a deterioration of eGFR was observed [ 26 ].…”

Section: Treatment Approachmentioning

confidence: 99%

“…It is administered mostly for steroid-resistant TCMR. However, basing on small clinical study it is encouraged for the prompt usage upon CA TCMR diagnosis [ 26 ]. On the other hand, the high probability of undesirable events including neutropenia and Cytomegalovirus (CMV) antigenemia often results in the stoppage of escalated immunosuppression.…”

Section: Treatment Approachmentioning

confidence: 99%

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Chronic Active T-Cell Mediated Kidney Rejection as a Clinically Significant Type of Allograft Loss?

et al. 2022

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The purpose of this article is to assess the present knowledge about chronic active (CA) T-cell mediated rejection (TCMR) of a kidney. In the research authors review current Banff diagnostic criteria used in kidney rejection, focus on their possible future evolution, and investigate the role of currently available molecular methods that could be implemented into the diagnostic scheme. Research also points out previously and currently available treatment methods applied to CA TCMR and takes into account possible side effects consequent upon the therapy. Moreover, attention is being paid to the CA TCMR coincidence with other kidney rejection types such as antibody-mediated rejection (ABMR) and its influence on the treatment approach. Authors also mark the possibility of non-HLA antibodies coexistence in patients with CA TCMR and describe its possible resonance on kidney allograft function. Nonetheless, it seems that current knowledge about CA TCMR is not sufficient and requires further investigation.

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Section: Treatment Approachmentioning

confidence: 99%

Section: Treatment Approachmentioning

confidence: 99%

Chronic Active T-Cell Mediated Kidney Rejection as a Clinically Significant Type of Allograft Loss?

et al. 2022

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“…Chronic active ABMR is the most widely recognized cause of allograft failure ( 117 ), whereas TCMR usually exists in a mixed rejection phenotype ( 118 ). Given current understanding that that chronic active TCMR is often associated with insufficient immunosuppression, TCMR treatment has been directed to increasing doses and types of anti-T cell immunosuppressive agents such as combinations of therapies with basiliximab, everolimus in addition to tacrolimus ( 119 ). Numerous therapies have been used in the clinical setting, mostly focusing on chronic active ABMR.…”

Section: New Therapies For the Treatment Of Cktrmentioning

confidence: 99%

Tackling Chronic Kidney Transplant Rejection: Challenges and Promises

et al. 2021

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Despite advances in post-transplant management, the long-term survival rate of kidney grafts and patients has not improved as approximately forty percent of transplants fails within ten years after transplantation. Both immunologic and non-immunologic factors contribute to late allograft loss. Chronic kidney transplant rejection (CKTR) is often clinically silent yet progressive allogeneic immune process that leads to cumulative graft injury, deterioration of graft function. Chronic active T cell mediated rejection (TCMR) and chronic active antibody-mediated rejection (ABMR) are classified as two principal subtypes of CKTR. While significant improvements have been made towards a better understanding of cellular and molecular mechanisms and diagnostic classifications of CKTR, lack of early detection, differential diagnosis and effective therapies continue to pose major challenges for long-term management. Recent development of high throughput cellular and molecular biotechnologies has allowed rapid development of new biomarkers associated with chronic renal injury, which not only provide insight into pathogenesis of chronic rejection but also allow for early detection. In parallel, several novel therapeutic strategies have emerged which may hold great promise for improvement of long-term graft and patient survival. With a brief overview of current understanding of pathogenesis, standard diagnosis and challenges in the context of CKTR, this mini-review aims to provide updates and insights into the latest development of promising novel biomarkers for diagnosis and novel therapeutic interventions to prevent and treat CKTR.

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“…According to a survey conducted by The Transplantation Society and CyberNephrology online forum, more than 80% of surveyed institutions making a diagnosis of CA‐TCMR were providing some form of treatment 2 . We also presented a report of three cases showing that intensive treatment improves the pathological findings of allografts in patients with CA‐TCMR 6 . However, data on the treatment of CA‐TCMR are scarce, and therapeutical strategies have not been established.…”

Section: Introductionmentioning

confidence: 99%

“…2 We also presented a report of three cases showing that intensive treatment improves the pathological findings of allografts in patients with CA-TCMR. 6 However, data on the treatment of CA-TCMR are scarce, and therapeutical strategies have not been established.…”

Section: Introductionmentioning

confidence: 99%

Treatment of chronic active T cell‐mediated rejection after kidney transplantation: A retrospective cohort study of 37 transplants

et al. 2022

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Aim Data on the treatment of chronic active T cell‐mediated rejection (CA‐TCMR) are scarce, and therapeutical strategies for CA‐TCMR have not been established. We retrospectively evaluated the outcomes and effects of treatment on pathological and clinical findings in patients with CA‐TCMR. Methods This study comprised 37 patients who underwent kidney transplantation at our institute who were diagnosed with CA‐TCMR between January 2018 and December 2020. Patients were followed until October 2021. Results A total of 32 of the 37 patients were treated. During the observation period, two patients died (5%), and five patients developed allograft loss (13%). A univariate Cox proportional hazards model showed that indication biopsy, higher spot urine protein/creatinine ratio (UPCR) and Banff ci/ct scores were risk factors for allograft loss. Of the treated patients, 23 underwent follow‐up biopsies. The Wilcoxon signed‐rank test showed significant improvement in the Baff scores for “ti”, “i‐IFTA”, “t” and “t‐IFTA” after treatment. On pathology, 13 (57%) of the patients who underwent follow‐up biopsy improved to “no evidence of rejection” or “borderline change.” Assuming that improvement in pathology to “borderline change” or “no evidence of rejection” on follow‐up biopsy indicates response to treatment, multivariate logistic analysis showed that lower UPCR was a predictive factor for response to treatment. No specific effect of treatment type was observed. Conclusions Our results indicate that treatment could improve the pathological findings in CA‐TCMR.

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Response to Treatment for Chronic-active T Cell–mediated Rejection in Kidney Transplantation: A Report of 3 Cases

Cited by 5 publications

References 11 publications

Chronic Active T-Cell Mediated Kidney Rejection as a Clinically Significant Type of Allograft Loss?

Chronic Active T-Cell Mediated Kidney Rejection as a Clinically Significant Type of Allograft Loss?

Tackling Chronic Kidney Transplant Rejection: Challenges and Promises

Treatment of chronic active T cell‐mediated rejection after kidney transplantation: A retrospective cohort study of 37 transplants

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