Separate Reporting of Clinical Acute Rejection and Subclinical Acute Rejections in Kidney Transplantation

Kumar, M. S. A.

doi:10.1097/01.tp.0000237223.69828.3e

Cited by 1 publication

(2 citation statements)

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“…SCAR is reported by few centers that perform surveillance or protocol biopsies and there are clinical differences between BPAR and SCAR. Most of the transplant centers do not report SCAR and we believe that combined reporting will cause confusion (22).…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Outcome of Early Steroid Withdrawal After Kidney Transplantation in African American Recipients Monitored by Surveillance Biopsy

Kumar¹,

Khan²,

Ranganna³

et al. 2008

American Journal of Transplantation

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Generally chronic steroid therapy is standard care for African American (AA) kidney recipients because of their higher incidence of rejections and lower longterm graft survival. This prospective study evaluated the long-term safety and efficacy of early steroid withdrawal (ESW) in AA recipients. A total of 206 recipients were studied; 103 AA and 103 non-AA recipients monitored by serial surveillance biopsies from 1 to 60 months posttransplantation to evaluate subclinical acute rejections (SCAR) and chronic allograft injury (CAI). Biopsy-proven clinical acute rejections (BPAR) and SCAR were treated. Primary end point was BPAR and secondary end points were 5-year SCAR, CAI and survival. Incidences of BPAR was 16% versus 14% (p = 1.0), prevalence of CAI due to hypertension was 48% versus 30% (p = 0.05) and interstitial fibrosis/tubular atrophy was 47% versus 32% (p = 0.05) and the mean serum creatinine levels were 2.1 versus 1.8 mg/dL (p = 0.05) at 5-years in AA versus non-AA recipients. The incidence of SCAR was 23% versus 11% at 1 month (p = 0.04), 12% versus 3% at 3 years (p = 0.04) and 10% versus 1% at 5 years (p = 0.04) in AA and non-AA recipients, respectively. Five-year patient survivals were 81% and 88% (p = 0.09) and graft survivals were 71% and 73%(p = 0.19) in AA and non-AA groups, respectively. After early steroid withdrawal AA kidney recipients have significantly lower renal function and higher SCAR and CAI but 5-year graft survival are comparable to non-AA recipients.

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Section: Discussionmentioning

confidence: 99%

“…Both BPAR and SCAR were graded per Banff schema (16,17). We are reporting BPAR and SCAR separately to avoid confusion and according to previous reports by other investigators (18–22).…”

Section: Methodsmentioning

confidence: 99%