Effects of Treating Subclinical Rejection 2 Weeks after Kidney Transplantation, as Determined by Analyzing 1-Year Histologic Outcomes

Abstract

Background: Subclinical rejection (SCR) is associated with chronic allograft nephropathy. Therefore, early detection and treatment of SCR through a protocol biopsy (PB) can reduce the incidence of pathological changes. This study evaluates the impact of early detection and treatment of subclinical rejection through the use of a routine PB 2 weeks after kidney transplantation (KT) by examining histologic outcomes 1 year later. Methods: We reviewed 624 KT recipients at Samsung Medical Center between August 2012 and December 2018. PB was planned 2 weeks and 1 year after transplantation. We compared the histological changes between the 2 biopsies. After a propensity score matching analysis, we divided the patients into 2 groups: the proven normal group (n = 256) and rejection group (n = 96) at the PB taken 2 weeks post-transplant. Results: The rejection group showed no significant difference from the normal group in the flow of graft function (eGFR) or the Kaplan-Meier curve for graft survival. In the histologic outcomes, the pathological differences between 2 groups showed significantly improved between the two time points. Conclusions: Treating SCR through a PB 2 weeks after KT can contribute to maintenance of graft function and improve histologic changes 1 year after KT.