Risk Factors for Banff Borderline Acute Rejection in Protocol Biopsies and Effect on Renal Graft Function

• Published in: Transplantation proceedings 2010-07, Vol.42 (6), p.2376-2378
• Main Authors: Espinoza, E.H, González-Parra, C, Macías-Díaz, D.M, Uribe-Uribe, N.O, Alberú, J, Morales-Buenrostro, L.E
• Format: Article
• Language: English
• Subjects: Acute Disease; Atrophy; Biological and medical sciences; Biopsy - methods; Epidemiology; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Glomerular Filtration Rate; Graft Rejection - epidemiology; Graft Rejection - pathology; HLA Antigens - immunology; Humans; Incidence; Kidney Transplantation - immunology; Kidney Transplantation - pathology; Kidney Transplantation - physiology; Male; Medical sciences; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.05.008

Abstract Introduction The interpretation and handling of Banff borderline acute rejection observed in protocol biopsies from patients with stable renal function continues to be controversial. Our objective was to identify the risk factors for borderline acute rejection on 1-year protocol biopsies and to evaluate their effect on renal graft function after 2 years' follow-up. Methods We included 82 kidney transplant recipients (KTR), who underwent 1-year protocol biopsies with normal or stable graft function. All KTR had follow-up of at least 2 years posttransplantation. We formed three groups: (1) KTR with a normal biopsy, (2) KTR with borderline changes, and (3) KTR with interstitial fibrosis/tubular atrophy (IF/TA). We searched for risk factors related to borderline injury. The main outcome to evaluate was renal function at 1 month, at protocol biopsy, and 2 years posttransplant. Results The 82 patients included in this study showed no differences in immunosuppression, gender, etiology of renal failure, or percentage of panel-reactive antibodies. The risk factors associated with borderline lesions were: at least one biopsy due to allograft dysfunction and acute rejection events during the first year posttransplant ( P = .011 and P = .021, respectively). Increased serum creatinine and estimated glomerular filtration rate decline were greater among the borderline lesion than the normal group, but similar to patients with IF/TA. Conclusion Renal function decline was greater among borderline and IF/TA groups. However, the sum of insults, and not only the borderline injury itself, produces greater declines in renal function with greater risk for graft loss.