Histological Findings in Early Routine Biopsies of Stable Renal Allograft Recipients

Rush, David; Henry, Stephen F.; Jeffery, John; Schroeder, Timothy; Gough, James

doi:10.1097/00007890-199401001-00009

Cited by 231 publications

(123 citation statements)

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“…Although some authors suggest that protocol-or sequential biopsy would be important to detect subclinical rejection during the first three months after transplantation [24], recipients in our country are reluctant to accept these examinations out of fear from graft loss in a situation of donor scarcity. Non-invasive methods being favoured, we have previously used urinary neopterin and P2-microglobulin to detect renal graft rejection early [14].…”

Section: Discussionmentioning

confidence: 99%

IL-17 expression as a possible predictive parameter for subclinical renal allograft rejection

Hsieh¹,

Loong²,

Lui³

et al. 2001

Transplant International

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In the present study we have tried to establish the role of IL-17 in subclinical renal allograft rejection. In this animal model, renal grafts from BN (RT1") were transplanted heterotopically into LEW (RT1') rats. As controls, LEW grafts were transplanted into LEW rats. The histopathological examination demonstrated that the changes in the allograft kidney on day 2 were similar to those ranked as borderline changes according to the Banff classification scale. On day 2, the serum level of blood urea nitrogen (BUN) and creatinine were the same as on day 1. The examination of allograft cytokines mRNA showed that IL-17 mRNA expressed earlier on the second postoperative day, peaked at day 5, and then declined, becoming almost undetectable at day 9, when most rats died. IL-17 antigen was also proven, by histochemical staining, to be expressed early, however we could not find the same early appearance on other Thl/Th2 cytokines. In human renal biopsy samples, the IL-17 antigen could be found scattered around in the borderline changed rejected renal allografts without evidence of a serum creatinine increase, but was undetectable both in normal controls and in renal transplant tissue without signs of rejection. IL-17 mRNA was detected in the mononuclear cells of the urinary sediment of patients suffering from borderline subclinical rejection. From the above results we can hypothesize that IL-17 could serve as a predictive parameter for borderline subclinical renal allograft rejection in the future.

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Section: Discussionmentioning

confidence: 99%

IL-17 expression as a possible predictive parameter for subclinical renal allograft rejection

Hsieh¹,

Loong²,

Lui³

et al. 2001

Transplant International

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“…The first reports describing subclinical rejection were in patients who did not receive antibody induction and were treated with cyclosporine-based immunosuppressive regimens (6,8,9,18 -20) with (20) or without (6,9,18,19) mycophenolate mofetil (MMF). The prevalence of subclinical rejection between months 1 and 3 was approximately 25 to 30%.…”

Section: Prevalence Of Subclinical Rejectionmentioning

confidence: 99%

Protocol Transplant Biopsies

Rush¹

2006

Clinical Journal of the American Society of Nephrology

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“…The term "subclinical acute rejection" coined by Rush and associates using the Banff schema showed that subclinical acute rejection occurred in 30% to 45% of well-functioning grafts by 3 months after transplant and resulted in increased IF/TA by 12 months. 7,15,16 In addition, early protocol subclinical acute rejection findings were shown to have lower eGFR and were linked to increased risk of graft loss at 5 years. 3,8 In contrast, our study did not show an association between early protocol biopsy SAR+IF/TA and long-term graft function, likely because evidence favors treating SAR+IF/TA when diagnosed early after transplant.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Zachariah

Dwivedi²,

Yip³

et al. 2018

Exp Clin Transplant

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Objectives: Prognostic implications of early protocol biopsies have been studied; however, the value of late protocol biopsy in predicting graft outcome has not been well defined. Here, we compared the effects of early and late protocol biopsy histologic findings in stable kidney allografts and aimed to understand the significance of "borderline" rejection on allograft function. Materials and Methods: We studied 261 biopsies from 159 renal transplant recipients who were on a steroidfree, calcineurin inhibitor and mycophenolate mofetil regimen and who received transplants between 2004 and 2012 with mean follow-up of 5 years. Early (between 3 and 9 mo) and subsequent late (between 12 and 24 mo) protocol biopsies were performed. Biopsies were classified as normal, interstitial fibrosis and/or tubular atrophy, subclinical acute rejection with interstitial fibrosis and/or tubular atrophy, and borderline rejection with interstitial fibrosis and/or tubular atrophy. A linear mixed-effects model was used to determine the effects of early and late protocol biopsies on estimated glomerular filtration rate changes, with baseline time for estimated glomerular filtration rate fixed at 12 months. Results: The adjusted model showed that estimated glomerular filtration rate at 3 months, donor age, delayed graft function, and early protocol biopsies were associated with baseline estimated glomerular filtration rate at 12 months. Estimated glomerular filtration rate changes over time were associated with findings of interstitial fibrosis and/or tubular atrophy at early biopsy and subclinical acute rejection and borderline rejection at late biopsy. At last follow-up, final estimated glomerular filtration rate was significantly associated with interstitial fibrosis and/or tubular atrophy at early biopsy and with subclinical acute rejection at late biopsy. Conclusions: Although early protocol biopsy predicted baseline estimated glomerular filtration rate, late biopsy was important for predicting changes in function over time. In addition, a diagnosis of "borderline" rejection on protocol biopsies predicted long-term graft function.

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Histological Findings in Early Routine Biopsies of Stable Renal Allograft Recipients

Cited by 231 publications

References 0 publications

IL-17 expression as a possible predictive parameter for subclinical renal allograft rejection

IL-17 expression as a possible predictive parameter for subclinical renal allograft rejection

Protocol Transplant Biopsies

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