The Impact of Early Clinical and Subclinical T Cell Mediated Rejection after Kidney Transplantation

Background: We investigated the effect of Clinical and Subclinical T Cell Mediated Rejection (C-TCMR and SC-TCMR) on allograft histology, function and progression. Methods: Adult kidney recipients with 2 protocol biopsies were divided into: No-TCMR (No-TCMR) on biopsies (n=104), SC-TCMR (n=56), and C-TCMR (n=32) in at least 1 biopsy. Chronicity (ci+ct+cg+cv) scores, renal function, and the burden of renal disease measured by AUC (serum creatinine mg*month/dl) were compared. Results: Baseline characteristics were similar except for mean donor age and KDPI scores. Patients with C-TCMR had higher mean serum creatinine, lower mean eGFR and higher AUC with 95% CI [75.2 (67.7,82.7)] as opposed to patients with SC-TCMR and No-TCMR [58.3 (53.6,62.9), 65.1 (58.8,71.5)], p=0.0004. Chronicity scores were higher at 3 months in C-TCMR (2.30±1.58) when compared to SC-TCMR (2.02±1.42) and No-TCMR (1.31±1.18), p=0.0001] and also at 12 months. At last follow-up 18.8% patients with C-TCMR had >50% decline in eGFR from 3 months compared to 7% and 1% among No-TCMR and SC-TCMR groups, (p=0.038). Multivariate analyses revealed a higher odds of delta-creatinine >0.5 mg/dl from 3 months to last follow-up for C-TCMR [3.39 (95%CI: 1.25, 9.20)] vs. No-TCMR (p=0.016). Conclusions: Kidney transplant recipients with C/SC-TCMR have heightened early allograft chronicity and worse renal function compared to No-TCMR. Progressive renal dysfunction was noted among patients with C-TCMR as opposed to SC-TCMR and No-TCMR. Conflict of Interest disclosure for all authors: None Corresponding Author: Sundaram Hariharan, MD, Professor of Medicine and Surgery, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, 3459 Fifth Avenue, 7S, Pittsburgh, PA 15213, Tel: 412-647-5688, Fax: 412-647-5800, Email: hariharans@upmc.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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