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

Abstract Background There are few studies of histologic acute graft pyelonephritis (HAGPN) following kidney transplant (KT). The goals of this study are to determine incidence, identify potential risk factors and describe outcomes of HAGPN in a large cohort of KT recipients. Methods Renal allograft biopsies of all patients undergoing first KT at our medical center between 2008 and 2017 were reviewed. HAGPN was defined as the presence of neutrophils within the interstitium and tubules (casts). Medical charts of patients with HAGPN were reviewed. Episodes of bacteriuria (≥10:5 cfu/mL growth in culture) were classified as urinary tract infection (UTI) or asymptomatic bacteruria (ASB) based upon documented symptoms. An episode of acute rejection was defined as pulse parenteral immunosuppressive therapy for histologic evidence of rejection. Results HAGPN was identified in 43 of 1,391 (3.1%) KT recipients at a median of 298 days post-transplant. There were no significant differences between recipient age or gender, donor age or transplant type (deceased, living related, living unrelated) between recipients with and without HAGPN. Urologic malformation was diagnosed in 14 (33%) by day 30 post-transplant. Twenty-five (58%), 17 (40%), and 13 (30%) sustained one or more episodes of acute rejection, UTI and ASB, respectively, prior to HAGPN. At diagnosis of HAGPN, 28 (65%), 7 (16%), and 16 (37%) had histologic evidence of rejection, UTI and ASB, respectively. Twenty-two (51%) and 37 (86%) were treated with pulse immunosuppression and antibiotics, respectively. Median nadir serum creatinine before HAGPN was 1.1 mg/day while median serum creatinine at 6 and 12 months after HAGPN were 1.5 and 1.6. Three patients (7%) developed graft failure within 1 year after HAGPN. Conclusion HAGPN is an infrequent complication of KT. A majority of patients with HAGPN have histologic evidence of rejection and either UTI or ASB at diagnosis, though over 40% have neither UTI nor ASB. When rejection accompanying HAGPN is routinely treated with pulse immunosuppression and antibiotic therapy is administered, graft function is preserved for most patients but a minority (7%) loses graft function within 1 year. Potential risk factors to be assessed in further study include post-transplant urologic dysfunction, acute rejection and UTI. Disclosures All authors: No reported disclosures.

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Risk Factors for Delayed Renal Graft Function and Their Impact on Renal Transplantation Outcome

Transplantation Proceedings ◽

10.1016/j.transproceed.2007.07.032 ◽

2007 ◽

Vol 39 (8) ◽

pp. 2473-2475 ◽

Cited By ~ 15

Author(s):

A. Figueiredo ◽

P. Moreira ◽

B. Parada ◽

P. Nunes ◽

F. Macário ◽

...

Keyword(s):

Risk Factors ◽

Renal Transplantation ◽

Graft Function ◽

Renal Graft

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Sub-clinical acute rejection detected using protocol biopsies in patients with delayed graft function

Transplant International ◽

10.1007/s001470050274 ◽

2000 ◽

Vol 13 (7) ◽

pp. S52-S55 ◽

Cited By ~ 15

Author(s):

S. Jain ◽

V. Curwood ◽

S. A. White ◽

P. N. Furness ◽

M. L. Nicholson

Keyword(s):

Acute Rejection ◽

Graft Function ◽

Delayed Graft Function ◽

Protocol Biopsies

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IMMUNOCYTOLOGY OF URINARY SEDIMENTS AS A METHOD OF DIFFERENTIATING ACUTE REJECTION FROM OTHER CAUSES OF DECLINING RENAL GRAFT FUNCTION

Transplantation Journal ◽

10.1097/00007890-199108000-00015 ◽

1991 ◽

Vol 52 (2) ◽

pp. 266-271 ◽

Cited By ~ 11

Author(s):

INK M. M. DOOPER ◽

M. JOSE J. T. BoGMAN ◽

ANDRIES J. HOITSMA ◽

CATHY N. MAASS ◽

PETER G. VOOIJS ◽

...

Keyword(s):

Acute Rejection ◽

Graft Function ◽

Renal Graft

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Delayed Renal Graft Function: Risk Factors and Impact on the Outcome of Transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2010.12.023 ◽

2011 ◽

Vol 43 (1) ◽

pp. 100-105 ◽

Cited By ~ 27

Author(s):

P. Moreira ◽

H. Sá ◽

A. Figueiredo ◽

A. Mota

Keyword(s):

Risk Factors ◽

Graft Function ◽

Renal Graft

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P1772CONVERSION TO BELATACEPT IMPROVES RENAL GRAFT FUNCTION OF PATIENTS WITH SEVERE HISTOLOGICAL AND FUNCTIONAL INVOLVEMENT. LONG-TERM UNICENTRIC EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1772 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Maria Ovidia Lopez-Oliva ◽

Laura Alvarez Garcia ◽

Tamara Perez Robles ◽

Marco Antonio Vaca Gallardo ◽

Santacruz Juan ◽

...

Keyword(s):

Renal Function ◽

Acute Rejection ◽

De Novo ◽

Graft Function ◽

Vascular Lesions ◽

Kidney Graft ◽

Contralateral Kidney ◽

Renal Graft ◽

Functional Involvement

Abstract Background and Aims Belatacept selectively blocks the costimulation signal of T cells. Its use, both de novo and in conversion, is associated with a better renal graft function compared to the regimens that include a calcineurin inhibitor (CNI). We expose our experience with belatacept as a rescue therapy in patients who present moderate-severe dysfunction after renal transplantation and compare the evolution with those patients who received the contralateral kidney graft without change to belatacept. Method Adult kidney transplanted patients, with graft dysfunction and renal biopsy with CNI toxicity or chronic vascular lesions who are changed from CNI to belatacept were included. Efficacy (creatinine, proteinuria, TFGe, acute rejection tested by biopsy, anti HLA) and safety (adverse events, tumors or infections) variables were recorded before and after the change. Results 11 patients were included. The change to belatacept was made at a median of 13 months from the transplant (range 1-62 months) and the duration of the treatment ranged between 6 and 74 months. Renal function improved from a mean creatinine of 3.04±1.34 mg/dl before the change to 1.9±0.3 mg/dl at 6 and 12 months after conversion (p = 0.016), being the last average creatinine (December 2019) of 1.7±0.3 mg/dl. Belatacept was withdrawn in one case, at one year, due to the development of specific donor antibodies without evidence of acute rejection. There were no cases of post-transplant lymphoproliferative syndrome. Two patients developed VBK replication controlled with immunosuppression modification and three patients developed CMV infection controlled with valganciclovir. There was no episode of acute rejection after conversion. In 5 cases the contralateral kidney graft was not implanted, while in 6 cases it was implanted in another recipient who was not given belatacept and was taken on CNI therapy. The last average creatinine (December 2019) of patients without belatacept was 3.3±1.6 mg/dl vs. 1.6±0.2 mg/dl in patients with belatacept (p = 0.03). Conclusion The change to belatacept improves the renal function of all patients, even in those with severe histological and functional involvement. The improvement of renal function remains stable in the medium/long term and is significantly better than the renal function of patients with CNI.

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P1640COLONIZATION AND INFECTION WITH ESBL-PRODUCING AND CARBAPENEM-RESISTANT ENTEROBACTERIACIEAE IN KIDNEY TRANSPLANT RECIPIENTS: RISK FACTORS, IMPACT OF RENAL GRAFT FUNCTION AND USE OF HOSPITAL RESOURCES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1640 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Alessandra Palmisano ◽

Eleonora Salsi ◽

Paride Fenaroli ◽

Anna Maria Degli Antoni ◽

Ilaria Gandolfini ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplant ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Post Transplantation ◽

Renal Graft ◽

Carbapenem Resistant ◽

Hospital Resources

Abstract Background and Aims ESBL-producing and carbapenem resistant (CR) Enterobacteriaceae are a common cause of severe infection, morbidity and mortality in kidney transplant recipients (KTR). Few studies have investigated the risk factors for ESBL-producing/CR Enterobacteriaceae colonization and infection in this group of patients, the effect of colonization and infection on KTR’s renal graft function, and the use of hospital resources. Method Retrospective follow-up study on a consecutive series of patients undergoing kidney transplantation at Parma University Hospital (Italy) between January-2016 and December-2018. We performed a multivariable-adjusted analysis of the predictive factor associated with MDR infection/colonization via general linear models for prevalence- and risk- ratio. Renal function (eGFR) decline was compared by mixed-effects random-coefficients models, hospital resources by negative binomial regression. Results We enrolled 180 KTR (mean recipient’s age: 52.4 [SD 12.4]; males 65%; mean donor’s age: 54.6 [SD 15.6]) and followed them up for 2-years post transplantation. Cumulative prevalence of colonization 3-months post-transplantation and cumulative incidence of infection were 26.1% and 9.4% for ESBL, and 4.4% and 1.6% for CR. ESBL colonization was associated with hemodialysis vs peritoneal dialysis (93% vs 70% non-colonized; adjusted RR 0.21 [95% CI: 0.06 to 0.98]), dialysis vintage (mean months: 65 vs 42; adjusted associated with being above the median, RR 2.17 [95% CI: 1.32 to 3.55]) and retention of ureteral stent for more than one month after transplant (28% vs 12%; adjusted RR 2.09 [95% CI: 1.27 to 3.44]) ; ESBL infection was associated with retention of ureteral stent (47% vs 13%; adjusted RR 4.89 [95% CI 2.11 to 11.35]) whereas CR colonization was associated with surgical complication during transplant admission (50% vs 15%; adjusted RR 4.61 [95% CI 1.28 to 16.66]). Two patients (both with CR) died over the study follow-up, whereas none of the patients lost the graft. CR infection was associated lower baseline (3-months post-transplantation) eGFR compared to the other groups (-28.4mL/min/1.73m2 [95% CI: -50.5 to -6.3]); a numerically more rapid decline (up to - 5mL/min/year) of eGFR, albeit not statistically significant, was observed in patients with CR colonization compared to non-colonized at 2 years of follow-up. In comparison with non-colonized patients, adjusted mean days of carbapenem treatment in ESBL/CR colonized/infected was 5.7 vs 0.7 (P=0.003); length-of-hospital stay 5.8 vs 1.0 (P=0.055); days on drug-resistant-infection intravenous-outpatient-therapy 20.7 vs 0.1 (P= 0.008). Conclusions The study shows that ESBL and CR colonization and infection in KTR are statistically associated with longer hemodialysis vintage, urological procedures, and surgical complications. They cause an increase in the hospital resources use and may jeopardize transplant outcomes.

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Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome

Journal of Transplantation ◽

10.1155/2015/163757 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 21

Author(s):

Martin Chaumont ◽

Judith Racapé ◽

Nilufer Broeders ◽

Fadoua El Mountahi ◽

Annick Massart ◽

...

Keyword(s):

Risk Factors ◽

Acute Rejection ◽

Reperfusion Injury ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Graft Function ◽

Graft Outcome ◽

Saline Loading ◽

Residual Diuresis

Background. Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion injury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft outcome remains controversial.Methods. From 1983 to 2014, 1784 kidney-only transplantations from deceased donors were studied. Classical risk factors for DGF along with two novel ones, recipient’s perioperative saline loading and residual diuresis, were analyzed by logistic regression and receiver operating characteristic (ROC) curves.Results. Along with other risk factors, absence of perioperative saline loading increases acute rejection incidence (OR = 1.9 [1.2–2.9]). Moreover, we observed two novel risk factors for DGF: patient’s residual diuresis ≤500 mL/d (OR = 2.3 [1.6–3.5]) and absence of perioperative saline loading (OR = 3.3 [2.0–5.4]). Area under the curve of the ROC curve (0.77 [0.74–0.81]) shows an excellent discriminant power of our model, irrespective of rejection. DGF does not influence patient survival(P=0.54). However, graft survival is decreased only when rejection was associated with DGF(P<0.001). Conclusions. Perioperative saline loading efficiently prevents ischemia-reperfusion injury, which is the predominant factor inducing DGF. DGFper sehas no influence on patient and graft outcome. Its incidence is currently close to 5% in our centre.

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Impact of Subclinical Acute Rejection on Renal Graft Function: Results of Three-Year Follow-Up

Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences ◽

10.2478/prolas-2013-0008 ◽

2013 ◽

Vol 67 (1) ◽

pp. 42-46

Author(s):

Vadims Suhorukovs ◽

Tatjana Tihomirova

Keyword(s):

Graft Function ◽

Long Term Results ◽

Renal Graft ◽

Significant Difference ◽

Protocol Biopsies ◽

Post Operation ◽

Renal Grafts ◽

Subclinical Rejection

Notwithstanding that in the last years the immediate results of kidney transplantation have been improved, there has been no adequate improvement of long-term results. Therefore, more attention is being paid to the so-called subclinical rejections of renal grafts, detected by protocol biopsies, as a possible factor affecting renal function in late period. The aim of this study was to determine the frequency of subclinical rejections and their impact on further renal graft function. Within the frame of the study 40 protocol biopsies were performed in 26 patients with immediate and stable renal graft function. In 17 (65.4%) of them a subclinical rejection of IA-IIA degree was detected. In nine patients with subclinical rejection, treatment with steroids was applied, while eight recipients did not receive any additional therapy. In follow-up, in a period of three years there was no statistically significant difference in blood creatinine level, glomerular filtration rate, number of clinical rejections during the monitoring period, and three-year survival of the transplanted kidney in patients, regardless of where the treatment of subclinical rejection was applied. The results of our study did not indicate any impact of subclinical rejection on renal graft function in the late post-operation period.

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