14. Trends in acute cellular rejection in renal transplant biopsies

• Published in: Pathology Vol. 45; pp. S108 - S109
• Main Authors: Lam, Kin, Wang, Chao, Stoyanov, Alex, Chen, Jason, Gill, Anthony
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 2013
• DOI: 10.1097/01.PAT.0000427014.18676.55
• ISSN: 0031-3025

Acute cellular rejection (ACR) and immunosuppressant drug tox-icity are two common acute pathologies that affect a large proportion of post-transplant patients. This study investigated the incidence of ACR in renal transplant biopsies with acute pathology at Pacific Laboratory Medicine Services (PaLMS) over a 13 year period (January 1998 – April 2011). A database analysis using the search terms ‘Renal’, ‘Biopsy/Bx’ and ‘Transplant/Tx/Rejec-tion’, yielded 190 cases with acute pathology. ACR incidence rate in these biopsies was 48% overall (n=92) and fluctuated around 40–60% annually. Those without ACR were found to have a threefold higher incidence of suspected acute calcineurin inhibitor drug toxicity, although 15% of cases with ACR also displayed concurrent suspected acute drug toxicity. Due to the non-specific nature of the histological features of acute drug toxicity, drug toxicity could only be suspected or suggested in most reports rather than conclusively identified. Pre-biopsy blood tacrolimus and cyclospo-rine levels did not show correlation with ACR incidence, although a difference was evident in pre-biopsy blood cyclosporine levels between patients with and without ACR. However, the variable nature of individual responses to drugs as well as other factors means that no definitive conclusion can be read into this result as the optimal dosage will vary between individuals.