The Severity of Acute Cellular Rejection Defined by Banff Classification Is Associated With Kidney Allograft Outcomes

Abstract

All types of ACR affect long-term graft survival. Vascular or late ACR predict poorer graft survival; the extent of tubulointerstitial inflammation (TI) is of no prognostic significance for vascular rejection.

Efficacy of Acute Cellular Rejection Treatment According to Banff Score in Kidney Transplant Recipients: A Systematic Review

“…13,14 One report was restricted to patients with steroid resistant rejection. 13 Biopsies were performed for clinical motives in all studies, with indications including delayed graft function, 15,16 and increase in serum creatinine levels. 11,13-16 One study included a small percentage of rejections diagnosed on surveillance biopsies (3%).…”

Induction Therapy in Renal Transplantation

“…This statistical approach has not been previously used when addressing this topic and is superior to previous meta-analyses and retrospective analyses that have attempted to compare induction agents (4,5). The weaknesses of this study and all other retrospective studies examining the effect of induction include (1) the lack of information regarding the intensity of maintenance immunosuppression (for example, higher TAC trough levels may have been used in the absence of induction), (2) the uncertainty regarding the longer-term effect of induction on graft survival (the mean time of followup was approximately 4 years, perhaps too short to determine long-term safety of depleting antibody strategies [6,7]), (3) the lack of clarity in determining the influence of rejection on graft outcomes (the type and severity of rejection and the response to therapy, important factors in assigning prognosis, may be different if rejection occurred after induction with one agent versus another or in the absence of induction [8]), and finally, (4) the lack of information regarding longer-term markers of immunologic injury, such as the rates of de novo donor-specific antibody formation in both those with or without induction and those with rejection under various induction strategies (3). Although rejection is a risk factor for future donor-specific antibody formation, is not known if induction or a specific induction agent alters this predilection (9).…”

Identification of T Cell–Mediated Vascular Rejection After Kidney Transplantation by the Combined Measurement of 5 Specific MicroRNAs in Blood

“…5,6 As an approved noninvasive method for monitoring graft function the measurement of serum creatinine indicates graft damage at a late timepoint and does not distinguish between types of rejection. Otherwise, the histological analysis of material retained from percutaneous biopsies allows a precise diagnosis but cannot be applied as a routine procedure for renal allograft monitoring.…”

“…Compared to patients with tubulointerstitial rejection, patients with vascular rejection episodes have a higher rate of graft loss. 5,6 Additionally, the likelihood of responding to antirejection therapy diminishes with the severity of vascular rejection. 7 Thus, the accurate, early, noninvasive and technically fast diagnosis of vascular rejection is clinically mandatory.…”