Study of Acute Antibody-Mediated Rejection in Renal Allograft Biopsies

• Published in: Transplantation proceedings Vol. 40; no. 4; pp. 1099 - 1103
• Main Authors: Kanodia, K.V, Vanikar, A.V, Trivedi, H.L
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2008; Elsevier Science
• Subjects: Adolescent; Adult; B-Lymphocytes - immunology; Biological and medical sciences; Biopsy; Child; Cyclosporine - therapeutic use; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - drug therapy; Graft Rejection - immunology; Graft Rejection - pathology; Humans; Immunosuppressive Agents - therapeutic use; Isoantibodies - immunology; Kidney Transplantation - immunology; Kidney Transplantation - pathology; Medical sciences; Methylprednisolone - therapeutic use; Middle Aged; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; T-Lymphocytes - immunology; Tacrolimus - therapeutic use; Tissue, organ and graft immunology; Transplantation, Homologous; Graft(material); Antibody; Acute; Transplantation; Homotransplantation; Kidney; Medicine; Rejection; Anatomic pathology; Treatment; Urinary system; Biopsy; Surgery; Graft
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.03.112

Abstract Introduction Acute B-cell-mediated rejection (AMR) was ill-defined until the 6th Banff meeting establishing the criteria. We performed a retrospective analysis of renal allograft biopsies to evaluate immune injury with reference to the Ahmedabad Tolerance Induction Protocols (ATIP). Methods We evaluated renal allograft biopsies belonging to 3 groups: group A patients (n = 120) underwent a modified ATIP with addition of mesenchymal stem cells, anti-B-cell antibodies, and higher target-specific irradiation; group B patients (n = 351) belong to the old ATIP; and group C (n = 142) were controls who opted out of ATIP. The majority were biopsied 2 or 3 times. Biopsies were subdivided: ≤60 days, 61 to 180 days, or 181 to 365 days' posttransplant. We compared demographics and diagnoses per the modified Banff criteria. Results At ≤60 days' posttransplantation, acute T-cell-mediated rejection (ATIR) was noted in 1.7% of group A patients; 5.98% of B; 33.8% of C with AMR in 11.7% of A; 10.8% of B; and 24.6% of C. At 61 to 180 days' posttransplant, ATIR was absent in group A, 1.99% in group B, and 21.83% in controls, whereas AMR was absent in group A; 1.7% in group B; and 39.4% of controls. At 181 to 365 days, ATIR and AMR were absent in group A; ATIR was 0.56% in group B and 14.1% in controls; AMR was 0.85% in group B and 21.1% in controls. The immunosuppression included cyclosporine (mg/kgBW/day) was 1.5 ± 0.1 in group A; 2 ± 0.5 in group B; and prednisone (mg/kgBW/day), 0.15 in group A, 0.2 in group B. The controls received standard doses. Conclusion The modified ATIP has reduced immunosuppressive drug dose requirements and lessened ATIR; however, AMR, although significantly less than controls, needs to be addressed.