Risk Factors for Banff Borderline Acute Rejection in Protocol Biopsies and Effect on Renal Graft Function

Espinoza, E.H.; González-Parra, Carlos; Macías-Díaz, D.M.; Uribe‐Uribe, Norma; Alberú, Josefina; Morales‐Buenrostro, Luis E.

doi:10.1016/j.transproceed.2010.05.008

Cited by 7 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Seron et al found no difference in serum creatinine at 1 and 2 years posttransplant between patients (n = 98) with normal histology and borderline changes at protocol biopsies performed at around 3 months . In contrast, Espinoza et al found a higher serum creatinine and greater decline in GFR at 2 years in subjects who had borderline changes in protocol biopsies done at 1 year . Some other studies have also shown similar findings …”

Section: Discussionmentioning

confidence: 86%

Short-term adverse effects of early subclinical allograft inflammation in kidney transplant recipients with a rapid steroid withdrawal protocol

Mehta

Bhusal

Randhawa

et al. 2018

American Journal of Transplantation

View full text Add to dashboard Cite

The impact of subclinical inflammation (SCI) noted on early kidney allograft biopsies remains unclear. This study evaluated the outcome of SCI noted on 3-month biopsy. A total of 273/363 (75%) kidney transplant recipients with a functioning kidney underwent allograft biopsies 3-months posttransplant. Among those with stable allograft function at 3 months, 200 biopsies that did not meet the Banff criteria for acute rejection were identified. These were Group I: No Inflammation (NI, n = 71) and Group II: Subclinical Inflammation (SCI, n = 129). We evaluated differences in kidney function at 24-months and allograft histology score at 12-month biopsy. SCI patients had a higher serum creatinine (1.6 ± 0.7 vs 1.38 ± 0.45; P = .02) at 24-months posttransplant, and at last follow-up at a mean of 42.5 months (1.69 ± 0.9 vs 1.46 ± 0.5 mg/dL; P = .027). The allograft chronicity score (ci + ct + cg + cv) at 12-months posttransplant was higher in the SCI group (2.4 ± 1.35 vs 1.9 ± 1.2; P = .02). The incidence of subsequent rejections within the first year in SCI and NI groups was 24% vs 10%, respectively (P = .015). De novo donor-specific antibody within 12 months was more prevalent in the SCI group (12/129 vs 1/71, P = .03). SCI is likely not a benign finding and may have long-term implications for kidney allograft function.

show abstract

Section: Discussionmentioning

confidence: 86%

Short-term adverse effects of early subclinical allograft inflammation in kidney transplant recipients with a rapid steroid withdrawal protocol

Mehta

Bhusal

Randhawa

et al. 2018

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…found no differences in allograft function at one- and 2-years post-transplantation between patients with and without SCI at 3-months post-transplantation [ 41 ]. Conversely, others found an impaired GFR at 2-years post-transplantation in SCI patients compared with normal biopsies [ 6 , 28 , 42 ]. Finally, a small randomized clinical trial, performed in low-immunological-risk KT recipients under TAC-based immunosuppression, showed a modest greater degree of fibrosis at 1 year in the CSW group, but more detailed information on SCI was not provided [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients

Hernández

Alonso-Titos

Vazquez

et al. 2021

JCM

View full text Add to dashboard Cite

The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 ± 1.2 vs. 5.7 ± 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 ± 14.9 vs. 125.7 ± 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients.

show abstract

“…The Banff score classifies biopsies with inflammation (i) ≥ 2 and tubulitis (t) ≥ 2 as acute cellular rejection, but i1 and t1 scores are also predictive, especially, if they are combined with other markers of injury. Borderline changes (defined by t > 0 without a diagnosis of acute rejection) are associated with a poorer outcome [36], and with a positive response to antirejection therapy in the context of allograft dysfunction. Mild or focal interstitial inflammation may only lead to a poorer outcome when associated with tubulitis [37].…”

Section: Fibrogenic Graft Injurymentioning

confidence: 99%

Clinical and histological predictors of long-term kidney graft survival

Galichon

Xu‐Dubois

Finianos

et al. 2013

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

Risk Factors for Banff Borderline Acute Rejection in Protocol Biopsies and Effect on Renal Graft Function

Cited by 7 publications

References 7 publications

Short-term adverse effects of early subclinical allograft inflammation in kidney transplant recipients with a rapid steroid withdrawal protocol

Short-term adverse effects of early subclinical allograft inflammation in kidney transplant recipients with a rapid steroid withdrawal protocol

Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients

Clinical and histological predictors of long-term kidney graft survival

Contact Info

Product

Resources

About