PMID- 34124342
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220423
IS  - 2373-8731 (Print)
IS  - 2373-8731 (Electronic)
IS  - 2373-8731 (Linking)
VI  - 7
IP  - 7
DP  - 2021 Jul
TI  - Impact of Subclinical and Clinical Kidney Allograft Rejection Within 1 Year 
      Posttransplantation Among Compatible Transplant With Steroid Withdrawal Protocol.
PG  - e706
LID - 10.1097/TXD.0000000000001132 [doi]
LID - e706
AB  - Early acute kidney rejection remains an important clinical issue. METHODS: The 
      current study included 552 recipients who had 1-2 surveillance or indication 
      biopsy within the 1 y posttransplant. We evaluated the impact of type of 
      allograft inflammation on allograft outcome. They were divided into 5 groups: no 
      inflammation (NI: 95), subclinical inflammation (SCI: 244), subclinical T 
      cell-mediated rejection (TCMR) (SC-TCMR: 110), clinical TCMR (C-TCMR: 83), and 
      antibody-mediated rejection (AMR: 20). Estimated glomerular filtration rate 
      (eGFR) over time using linear mixed model, cumulative chronic allograft 
      scores/interstitial fibrosis and tubular atrophy (IFTA) >/=2 at 12 mo, and survival 
      estimates were compared between groups. RESULTS: The common types of rejections 
      were C-TCMR (15%), SC-TCMR (19.9%), and AMR (3.6%) of patients. Eighteen of 20 
      patients with AMR had mixed rejection with TCMR. Key findings were as follows: 
      (i) posttransplant renal function: eGFR was lower for patients with C-TCMR and 
      AMR (P < 0.0001) compared with NI, SCI, and SC-TCMR groups. There was an increase 
      in delta-creatinine from 3 to 12 mo and cumulative allograft chronicity scores at 
      12 mo (P < 0.001) according to the type of allograft inflammation. (ii) Allograft 
      histology: the odds of IFTA >/=2 was higher for SC-TCMR (3.7 [1.3-10.4]; P = 0.04) 
      but was not significant for C-TCMR (3.1 [1.0-9.4]; P = 0.26), and AMR (2.5 
      [0.5-12.8]; P = 0.84) compared with NI group, and (iii) graft loss: C-TCMR 
      accounted for the largest number of graft losses and impending graft losses on 
      long-term follow-up. Graft loss among patient with AMR was numerically higher but 
      was not statistically significant. CONCLUSIONS: The type of kidney allograft 
      inflammation predicted posttransplant eGFR, cumulative chronic allograft 
      score/IFTA >/=2 at 12 mo, and graft loss.
CI  - Copyright (c) 2021 The Author(s). Transplantation Direct. Published by Wolters 
      Kluwer Health, Inc.
FAU - Owoyemi, Itunu
AU  - Owoyemi I
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Tandukar, Srijan
AU  - Tandukar S
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Jorgensen, Dana R
AU  - Jorgensen DR
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Wu, Christine M
AU  - Wu CM
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Sood, Puneet
AU  - Sood P
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Puttarajappa, Chethan
AU  - Puttarajappa C
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Sharma, Akhil
AU  - Sharma A
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Shah, Nirav A
AU  - Shah NA
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Randhawa, Parmjeet
AU  - Randhawa P
AD  - Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA.
FAU - Molinari, Michele
AU  - Molinari M
AD  - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
FAU - Tevar, Amit D
AU  - Tevar AD
AD  - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
FAU - Mehta, Rajil B
AU  - Mehta RB
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
FAU - Hariharan, Sundaram
AU  - Hariharan S
AD  - Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, 
      PA.
LA  - eng
PT  - Journal Article
DEP - 20210608
PL  - United States
TA  - Transplant Direct
JT  - Transplantation direct
JID - 101651609
PMC - PMC8191698
COIS- The authors declare no funding or conflicts of interest.
EDAT- 2021/06/15 06:00
MHDA- 2021/06/15 06:01
PMCR- 2021/06/08
CRDT- 2021/06/14 09:53
PHST- 2020/12/17 00:00 [received]
PHST- 2021/01/07 00:00 [revised]
PHST- 2021/01/09 00:00 [accepted]
PHST- 2021/06/14 09:53 [entrez]
PHST- 2021/06/15 06:00 [pubmed]
PHST- 2021/06/15 06:01 [medline]
PHST- 2021/06/08 00:00 [pmc-release]
AID - 10.1097/TXD.0000000000001132 [doi]
PST - epublish
SO  - Transplant Direct. 2021 Jun 8;7(7):e706. doi: 10.1097/TXD.0000000000001132. 
      eCollection 2021 Jul.