Subclinical Rejection in Tacrolimus-Treated Renal Transplant Recipients

Gloor, James M.; Cohen, Ari J.; Lager, Donna J.; Grande, Joseph P.; Fidler, Mary E.; Velosa, Jorge A.; Larson, Timothy S.; Schwab, Thomas R.; Griffin, Matthew; Prieto, Mikel; Nyberg, Scott L.; Sterioff, Sylvester; Kremers, Walter K.; Stegall, Mark D.

doi:10.1097/00007890-200206270-00023

Cited by 106 publications

(103 citation statements)

References 9 publications

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“…Our current definition of subclinical rejection requires that the serum creatinine be increased by Ͻ10% 2 wk before the protocol biopsy and that the histologic Banff score is "ai2at2" (type IA acute rejection) or greater. Numerous groups since have confirmed the occurrence of subclinical rejection as defined above, in both adults (7)(8)(9)(10)(11)(12)(13)(14) and children (15,16). Some investigators include "borderline" rejection (Banff score Ͻai2at2) in the subclinical rejection category (7,9 -11,14).…”

Section: Subclinical Rejection: Prevalence Risk Factors and Signifimentioning

confidence: 92%

“…More recent studies have reported on early subclinical rejection in patients who received tacrolimus, either with (10,11,13,21,22) or without (7) MMF. Jurewicz (7) reported a prevalence of subclinical rejection (that included "borderline") of 18% at 3 mo in patients who received kidneys from deceased donors and were treated with tacrolimus, azathioprine, and prednisone.…”

Section: Prevalence Of Subclinical Rejectionmentioning

confidence: 99%

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Protocol Transplant Biopsies

Rush¹

2006

Clinical Journal of the American Society of Nephrology

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Section: Subclinical Rejection: Prevalence Risk Factors and Signifimentioning

confidence: 92%

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 cost of biopsy can range between USD $1600 to $3000. 23 This must be weighed against the cost of missing a diagnosis of rejection.…”

Section: Discussionmentioning

confidence: 99%

Early Allograft Biopsies Performed During Delayed Graft Function May Not Be Necessary Under Thymoglobulin Induction

Ortíz

Parsikia²,

Mumtaz³

et al. 2012

Exp Clin Transplant

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Objectives: Delayed graft function affects up to 50% of kidney transplant recipients. Some guidelines recommend surveillance biopsies beginning 7 days after engraftment. This may be unnecessary with anti-thymocyte globulin induction. Materials and Methods: We conducted a retrospective study of deceased-donor renal transplant recipients with delayed graft function. Results: One hundred eleven patients met the inclusion criteria. The incidence of rejections during delayed graft function was 2.7%. They were diagnosed between 9 and 11 days after transplant. The subsequent incidence of rejection at 12-month follow-up was 13.5% (n=15). The median time to rejection after transplant was 10 weeks. Fourteen of 15 patients had subtherapeutic immunosuppression. The only risk factor associated with later rejection after delayed graft function was use of donors after cardiac death. Conclusions: Early rejection during delayed graft function with anti-thymocyte globulin induction and maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and steroids is rare. When later rejection occurs, it is at a median of 10 weeks after a transplant. Two of the 3 early rejections were antibody mediated. Later rejections were associated with subtherapeutic immunosuppression and donors after cardiac death. Biopsies need not be performed during the early postoperative period when anti-thymocyte globulin is used with tacrolimus, mycophenolate mofetil, and steroids.

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“…All adult patients (age Ͼ17 yr) who received a deceased donor renal transplant between 1991 and 2000 and whose grafts survived for at least 6 GFR was calculated using the creatinine, age, gender, and race. For understanding the time course in the improvement of GFR seen during the 1990s, the mean GFR was determined for each transplant year.…”

Section: Methodsmentioning

confidence: 99%

Factors Associated with Improvement in Deceased Donor Renal Allograft Function in the 1990s

Keith¹,

DeMattos²,

Golconda³

et al. 2005

Journal of the American Society of Nephrology

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The decade of the 1990s saw an improvement in cadaveric renal graft function and dramatic reduction in the acute rejection (AR) rate. The purpose of this study was to determine whether the reduction in rejection rate was the primary cause of the improvement in graft function seen and whether this improved long-term graft survival. All adult patients who received a cadaver renal transplant between 1991 and 2000 and had graft survival of at least 6 mo and complete data for creatinine at 6 mo, HLA mismatch, delayed graft function, and acute rejection (

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Subclinical Rejection in Tacrolimus-Treated Renal Transplant Recipients

Abstract: The incidence of subclinical rejection early after kidney transplantation is extremely low in tacrolimus-treated patients in whom early rejections are aggressively treated, suggesting that surveillance biopsies may not be necessary with this regimen.

Cited by 106 publications

References 9 publications

Protocol Transplant Biopsies

Protocol Transplant Biopsies

Early Allograft Biopsies Performed During Delayed Graft Function May Not Be Necessary Under Thymoglobulin Induction

Factors Associated with Improvement in Deceased Donor Renal Allograft Function in the 1990s

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