Subclinical acute rejections in protocol biopsies at 3 months after kidney transplantation

Czech version

Authors: I. Matl ¹; E. Honsová ²; A. Lodererová ²; V. Lánská ³; O. Viklický ¹
Authors‘ workplace: Klinika nefrologie IKEM Praha, přednosta doc. MUDr. Ondřej Viklický, CSc. ¹; Pracoviště klinické a transplantační patologie IKEM Praha, přednostka prim. MUDr. Eva Honsová, Ph. D. ²; Oddělení lékařské statistiky IKEM Praha ³
Published in: Vnitř Lék 2008; 54(11): 1054-1058
Category: Original Contributions

Overview

Aim:
The primary aim of the study was detection of subclinical acute rejection and borderline changes in protocol biopsies at 3 months after transplantation, and assessment of possible clinical and laboratory associations.

Methods:
Biopsy was carried out in 194 patients with stabilized graft function. Patients were treated with immunosuppressive regimen based on cyclosporine A (n = 34), tacrolimus (n = 152), or sirolimus/everolimus (n = 10). Samples were processed by standard paraffine technique, and stained according to laboratory protocol. All samples were tested by immunofluorescence or immunohistochemical procedures for C4d presence as a sign of humoral rejection.

Results:
Of 192 representative samples, subclinical acute rejection and borderline changes were found in 24 samples (12.5%). In patients with this finding, the mean serum creatinine was significantly higher (185.2 ± 2.2 µmol/L), than in patients with normal finding (128.2 ± 28.3 µmol/L) p < 0.001. Using the ROC curve analysis of serum creatinine, the cut‑off point 170 µmol/L was found to discriminate normal findings from subclinical rejection and borderline changes. A significant correlation between acute rejections before protocol biopsy and subclinical acute rejections together with borderline changes in protocol biopsy was found. C4d positivity was found in 6 samples. Immunosuppressive therapy (cyclosporine versus tacrolimus) did not have any impact on subclinical acute rejections and borderline changes prevalence.

Conclusions:
The main conclusion of this study is a finding, that acute rejection early after renal transplantation and serum creatinine ≥ 170 µmol/l at three months after transplantation are risks for development of subclinical acute rejection, even of humoral type, or borderline changes.

Key words:
kidney transplantation – protocol biopsy – subclinical acute rejection – borderline changes – immunosuppressive therapy

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