Risk Factors of Acute T‐Cell Mediated and Borderline Rejection Diagnosed in Early Protocol Kidney Transplant Biopsies


  • Marisa Roldão Serviço de Nefrologia, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal Author https://orcid.org/0000-0002-0448-0203
  • Ana Carlota Vida Serviço de Nefrologia, Hospital Central do Funchal, Funchal, Madeira, Portugal Author
  • Joana Monteiro Dias Serviço de Nefrologia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal Author
  • Miguel Bigotte Vieira Serviço de Nefrologia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal Author
  • Rita Magriço Serviço de Nefrologia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal Author
  • Cecília Silva Serviço de Nefrologia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal Author
  • Fernando Caeiro Serviço de Nefrologia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal Author
  • Inês Aires Serviço de Nefrologia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal Author
  • Aníbal Ferreira Serviço de Nefrologia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal Author


Basiliximab, Biopsy, Graft Rejection/diagnosis, Kidney Kidney Transplantation/adverse effects


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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Original Article

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Risk Factors of Acute T‐Cell Mediated and Borderline Rejection Diagnosed in Early Protocol Kidney Transplant Biopsies. (2024). Portuguese Kidney Journal, 38(1), 12-17. https://pkj.spnefro.pt/index.php/journal/article/view/19

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