Risk Factors of Acute T‐Cell Mediated and Borderline Rejection Diagnosed in Early Protocol Kidney Transplant Biopsies
Keywords:
Basiliximab, Biopsy, Graft Rejection/diagnosis, Kidney Kidney Transplantation/adverse effectsAbstract
Introduction: Acute graft rejection remains one of the main causes of graft dysfunction and premature loss. Under‐ standing the factors affecting graft rejection is essential to promote graft survival. Our study aimed to determine the incidence and assess risk factors of acute T‐cell mediated rejection (TCMR) and borderline rejection in early protocol kidney transplant biopsies.
Methods: Retrospective single‐center study of kidney transplant recipients between January 2021 and June 2022. Patients underwent protocol kidney biopsy during the first 2 weeks after transplantation. According to biopsy results, patients were classified into two groups: patients with TCMR or borderline rejection, and those without rejection. His‐ tological changes were evaluated and graded based on Banff classification 2019. Rejections in patients without delayed graft function requiring hemodialysis (HD) were classified as subclinical. Logistic regression analysis was performed to identify predictors of early acute rejection.
Results: Fourteen patients (15.9%) presented TCMR or borderline rejection, of which the majority (71.4%) had sub‐ clinical rejection. A significant higher proportion of patients with acute rejection were treated with basiliximab (13 (92.8%) vs 1 (7.2%), p=0.001). Patients with acute rejection had lower mean HLA mismatches (2.71 ± 0.83 vs 3.46 ± 1.41, p=0.011) and longer cold ischemia time, although not statistically significant (11.72 ± 5.39 vs 8.93 ± 3.56 hours, p=0.067). In the logistic regression analysis only induction therapy with basiliximab remained a strong predictor for early acute rejection [(OR) 36.8 (CI: 3.72 – 362.46), p=0.002].
Conclusion: In our cohort induction therapy with basiliximab appear to significantly increase the risk of early TCMR and bor‐ derline rejection. Early diagnosis with protocol kidney biopsies could be crucial to adopt the appropriate therapeutic strategies.
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Lemoine M, Titeca Beauport D, Lobbedez T, Choukroun G, Hurault de Ligny B, Hazzan M, et al. Risk Factors for Early Graft Failure and Death After Kidney Transplantation in Recipients Older Than 70 Years. Kidney Int Rep. 2019;4:656‐66. doi: 10.1016/j.ekir.2019.01.014.
Cooper JE. Evaluation and Treatment of Acute Rejection in Kidney Allografts. Clin J Am Soc Nephrol. 2020;15:430–8. doi: 10.2215/ CJN.11991019.
Oweira H, Ramouz A, Ghamarnejad O, Khajeh E, Ali‐Hasan‐Al‐Saegh S, Nikbakhsh R, et al. Risk Factors of Rejection in Renal Transplant Recipients: A Narrative Review. J Clin Med. 2022;11:1392. doi: 10.3390/ jcm11051392.
Lim MA, Kohli J, Bloom RD. Immunosuppression for kidney transplantation: Where are we now and where are we going? Transplant. Rev. 2017;31:10–7. doi: 10.1016/j.trre.2016.10.006.
Foroutan F, Friesen EL, Clark KE, Motaghi S, Zyla R, Lee Y, et al. Risk Factors for 1‐Year Graft Loss After Kidney Transplantation: Systematic Review and Meta‐Analysis. Clin J Am Soc Nephrol. 2019;14:1642‐50. doi: 10.2215/CJN.05560519.
Cavaleri M, Veroux M, Palermo F, Vasile F, Mineri M, Palumbo J, et al. Perioperative Goal‐Directed Therapy during Kidney Transplantation: An Impact Evaluation on the Major Postoperative Complications. J Clin Med. 2019;8:80. doi: 10.3390/jcm8010080.
Gao Y, Yu X, Feng X, Zhang Y. Factors related to postoperative prognosis of kidney transplant recipients: A retrospective analysis of 127 patients. Front Lab Med. 2018;2:63–7. doi: 10.1016/j.flm.2018.07.001
Loupy A, Haas M, Roufosse C, Naesens M, Adam B, Afrouzian M, et al. The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell‐ and antibody‐mediated rejection. Am J Transplant. 2020;20:2318‐31. doi: 10.1111/ajt.15898.
Sawinski D, Trofe‐Clark J, Leas B, Uhl S, Tuteja S, Kaczmarek JL, et al. Calcineurin Inhibitor Minimization, Conversion, Withdrawal, and Avoidance Strategies in Renal Transplantation: A Systematic Review and Meta‐Analysis. Am J Transplant. 2016;16:2117‐38. doi: 10.1111/ ajt.13710.
Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Castro S, et al. OPTN/SRTR 2017 Annual Data Report: Kidney. Am J Transplant. 2019;19 Suppl 2:19‐123. doi: 10.1111/ajt.15274.
Shapiro R, Randhawa P, Jordan ML, Scantlebury VP, Vivas C, Jain A, et al. An analysis of early renal transplant protocol biopsies‐the high incidence of subclinical tubulitis. Am J Transplant. 2001;1:47‐50. doi: 10.1034/j.1600‐6143.2001.010109.x.
Moreso F, Serón D, Carrera M, Gil‐Vernet S, Cruzado JM, Hueso M, et al. Baseline immunosuppression is associated with histological findings in early protocol biopsies. Transplantation. 2004;78:1064‐8. doi: 10.1097/01.tp.0000137268.85155.11.
Rowshani AT, Scholten EM, Bemelman F, Eikmans M, Idu M, Roos‐van Groningen MC, et al. No difference in degree of interstitial Sirius red‐stained area in serial biopsies from area under concentration‐over‐time curves‐guided cyclosporine versus tacrolimus‐treated renal transplant recipients at one year. J Am Soc Nephrol. 2006; 17: 305–12. doi: 10.1681/ASN.2005030249. Erratum in: J Am Soc Nephrol. 2006;17:1201.
Rush D, Arlen D, Boucher A, Busque S, Cockfield SM, Girardin C, Knoll G, et al. Lack of benefit of early protocol biopsies in renal transplant patients receiving TAC and MMF: a randomized study. Am J Transplant. 2007;7:2538‐45. doi: 10.1111/j.1600‐6143.2007.01979.x.
Mengel M, Gwinner W, Schwarz A, Bajeski R, Franz I, Bröcker V, et al. Infiltrates in protocol biopsies from renal allografts. Am J Transplant. 2007;7:356‐65. doi: 10.1111/j.1600‐6143.2006.01635.x.
Van Loon E, Lerut E, Senev A, Coemans M, Pirenne J, Monbaliu D, et al. The Histological Picture of Indication Biopsies in the First 2 Weeks after Kidney Transplantation. Clin J Am Soc Nephrol. 2020;15:1484‐ ‐93. doi: 10.2215/CJN.04230320.
Brennan DC, Schnitzler MA. Long‐term results of rabbit antithymocyte globulin and basiliximab induction. N Engl J Med. 2008;359:1736 ‐8. doi: 10.1056/NEJMc0805714.
Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9 Suppl 3:S1‐155. doi: 10.1111/j.1600‐6143.2009.02834.x.
Tanriover B, Jaikaransingh V, MacConmara MP, Parekh JR, Levea SL, Ariyamuthu VK, et al. Acute rejection rates and graft outcomes according to induction regimen among recipients of kidneys from deceased donors treated with tacrolimus and mycophenolate. Clin J Am Soc Nephrol. 2016;11:1650‐61. doi: 10.2215/CJN.13171215.
Laftavi MR, Alnimri M, Weber‐Shrikant E, Kohli R, Said M, Patel S, et al. Low‐dose rabbit antithymocyte globulin versus basiliximab induction therapy in low‐risk renal transplant recipients: 8‐year follow‐up. Transplant Proc. 2011;43:458‐61. doi: 10.1016/j. transproceed.2011.01.035.
Martinez‐Mier G, Moreno‐Ley PI, Budar‐Fernández LF, Méndez‐López MT, Allende‐Castellanos CA, Jiménez‐López LA, et al. Low‐dose Thymoglobulin vs Basiliximab Induction Therapy in Low‐Risk Living Related Kidney Transplant Recipients: A Prospective Randomized Trial. Transplant Proc. 2021;53:1005‐9. doi: 10.1016/j. transproceed.2020.01.054.
Gralla J, Le CN, Cooper JE, Wiseman AC. The risk of acute rejection and the influence of induction agents in lower‐risk African American kidney transplant recipients receiving modern immunosuppression. Clin Transplant. 2014;28:292‐8. doi: 10.1111/ctr.12311.
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Copyright (c) 2024 Marisa Roldão, Ana Carlota Vida, Joana Monteiro Dias, Miguel Bigotte Vieira, Rita Magriço, Cecília Silva, Fernando Caeiro, Inês Aires, Aníbal Ferreira (Author)
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