Persistent Chronic Active T-Cell-Mediated Rejection After Kidney Transplantation Is Associated With Poor Allograft Survival

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-10-30 DOI:10.1111/ctr.70011

Hiroshi Noguchi, Yuta Matsukuma, Kenji Ueki, Akihiro Tsuchimoto, Kei Nishiyama, Toshiaki Nakano, Shinsuke Kubo, Yu Sato, Keizo Kaku, Yasuhiro Okabe, Masafumi Nakamura

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引用次数: 0

Abstract

Introduction

Histopathological findings of chronic active T-cell-mediated rejection (CA-TCMR) have been reported to potentially improve with treatment. However, whether this improvement is associated with a better renal prognosis remains unclear. This study was performed to analyze the impact of the histological response to therapy on kidney allograft survival in patients with CA-TCMR.

Methods

The data of patients diagnosed with CA-TCMR between January 2018 and May 2023 were retrospectively reviewed. A composite graft endpoint was defined as a two-fold increase in the serum creatinine level or the development of end-stage kidney disease.

Results

Thirty-seven patients with CA-TCMR underwent 46 follow-up biopsies. Eleven patients who were diagnosed with CA-TCMR at the last biopsy were classified as the persistent group, while the remaining 26 patients were classified as the transient group. Both before and after treatment, there were no significant changes in serum creatinine, estimated glomerular filtration rate, or proteinuria in either group. However, the transient group showed a significant reduction in interstitial fibrosis and tubular atrophy without a specific etiology (IFTA). This improvement was attributed to better histopathological Banff scores after treatment. Patients with persistent CA-TCMR had significantly worse graft survival than those with transient CA-TCMR (p = 0.002), even after adjusting for significant clinical factors (hazard ratio: 11.4; 95% CI: 1.1–120.0; p = 0.043).

Conclusion

Our findings suggest that the persistence of histopathologic evidence of CA-TCMR after treatment is a significant risk factor for allograft loss compared with transient CA-TCMR.

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肾移植后持续的慢性活性 T 细胞介导的排斥反应与异体移植存活率低有关。

导言：据报道，慢性活动性 T 细胞介导的排斥反应（CA-TCMR）的组织病理学结果可能会随着治疗而改善。然而，这种改善是否与更好的肾脏预后相关仍不清楚。本研究旨在分析组织学治疗反应对 CA-TCMR 患者肾移植存活率的影响：回顾性回顾了2018年1月至2023年5月期间确诊为CA-TCMR患者的数据。复合移植物终点定义为血清肌酐水平升高两倍或出现终末期肾病：37 名 CA-TCMR 患者接受了 46 次随访活检。最后一次活检确诊为 CA-TCMR 的 11 名患者被归为持续组，其余 26 名患者被归为短暂组。治疗前后，两组患者的血清肌酐、估计肾小球滤过率和蛋白尿均无明显变化。不过，短暂组患者的间质纤维化和无特殊病因的肾小管萎缩（IFTA）明显减少。这种改善归因于治疗后组织病理学 Banff 评分的提高。持续性CA-TCMR患者的移植物存活率明显低于短暂性CA-TCMR患者（p = 0.002），即使在调整了重要的临床因素后也是如此（危险比：11.4；95% CI：1.1-120.0；p = 0.043）：我们的研究结果表明，与一过性 CA-TCMR 相比，治疗后 CA-TCMR 组织病理学证据的持续存在是导致同种异体移植损失的重要风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.