Pure T-cell mediated rejection following kidney transplant according to response to treatment

Abstract

The focus of studies on kidney transplantation (KT) has largely shifted from T-cell mediated rejection (TCMR) to antibody-mediated rejection (ABMR). However, there are still cases of pure acute TCMR in histological reports, even after a long time following transplant. We thus evaluated the impact of pure TCMR on graft survival (GS) according to treatment response. We also performed molecular diagnosis using a molecular microscope diagnostic system on a separate group of 23 patients. A total of 63 patients were divided into non-responders (N = 22) and responders (N = 44). Non-response to rejection treatment was significantly associated with the following factors: glomerular filtration rate (GFR) at biopsy, ΔGFR, TCMR within one year, t score, and IF/TA score. We also found that non-responder vs. responder (OR = 3.31; P = 0.036) and lower GFR at biopsy (OR = 0.56; P = 0.026) were independent risk factors of graft failure. The responders had a significantly superior overall GS rate compared with the non-responders (P = 0.004). Molecular assessment showed a good correlation with histologic diagnosis in ABMR, but not in TCMR. Solitary TCMR was a significant risk factor of graft failure in patients who did not respond to rejection treatment.

Difficult-to-Treat Rejections in Kidney Transplant Recipients: Our Experience with Everolimus-Based Quadruple Maintenance Therapy

“…In a previous study that classified all rejections according to Banff 2013 classification, the graft survival at 21 months after biopsy-proven diagnosis of any TCMR, where probably both acute and chronic TCMR were grouped together, was reported to be 54%, which appears to be significantly worse than the 90% found in our study for caTCMR alone at five years [33]. Pertaining to steroidresistant aTCMR, the 5-year graft survival rate of 67% observed in our study is slightly lower than the 70-80% reported in several past studies where thymoglobulin was used for steroid-resistant rejections [34][35][36]. However, the majority (63%) of our aTCMR patients included here had a contraindication for the use of thymoglobulin, which may explain the slightly lower rates observed in our study.…”

The Clinical Utility of Post-Transplant Monitoring of Donor-Specific Antibodies in Stable Renal Transplant Recipients: A Consensus Report With Guideline Statements for Clinical Practice

“…The temporal association between aABMR and chronic lesions associated with cABMR such as transplant glomerulopathy, peritubular capillary basement membrane multilayering and transplant arteriopathy is well described in both preclinical models and clinical studies [ 57 , 69 , 70 , 78 , 95 – 97 ]. Previous research in patients with TCMR has shown that chronic scarring is a determinate for poor response to treatment [ 98 , 99 ]. Haas et al [ 100 ] has also previously shown that early intervention in patients with ABMR may prevent chronic lesions such as transplant glomerulopathy.…”

The Outcome of Tapered Steroid Regimen When Used to Treat Acute Borderline Cellular Rejection After Kidney Transplant: A Single-Center Experience

“…"To treat or not to treat" has been the controversial question when a diagnosis of acute BCR is made on kidney allograft biopsy [3][4][5]. This dilemma is reinforced by multiple body of evidence to show beneficial long-term effect and others to show no gained benefit [6][7][8][9]. However, our transplant center follows a treatment approach and uses a rapid steroid regimen to treat all diagnosed acute BCR based on indicated or protocoled biopsies with a follow-up biopsy to assess the histopathologic response.…”