Long-term immunological outcomes of early subclinical inflammation on surveillance kidney allograft biopsies

医学 亚临床感染 活检 危险系数 内科学 肾功能 肾移植 优势比 队列 外科 置信区间
作者
Rajil Mehta,Ivy Melgarejo,Vignesh Viswanathan,Xingyu Zhang,Matthew Pittappilly,Parmjeet Randhawa,Chethan Puttarajappa,Puneet Sood,Christine Wu,Akhil Sharma,Michele Molinari,Sundaram Hariharan
出处
期刊:Kidney International [Elsevier]
卷期号:102 (6): 1371-1381 被引量:17
标识
DOI:10.1016/j.kint.2022.07.030
摘要

Abstract

The long-term impact of early subclinical inflammation (SCI) through surveillance biopsy has not been well studied. To do this, we recruited a prospective observational cohort that included 1000 sequential patients who received a kidney transplant from 2013-2017 at our center. A total of 586 patients who underwent a surveillance biopsy in their first-year post-transplant were included after excluding those with clinical rejections, and those who were unable to undergo a surveillance biopsy. Patients were classified based on their biopsy findings: 282 with NSI (No Significant Inflammation) and 304 with SCI-T (SCI and Tubulitis) which was further subdivided into 182 with SC-BLR (Subclinical Borderline Changes) and 122 with SC-TCMR (Subclinical T Cell Mediated Rejection, Banff 2019 classification of 1A or more). We followed the clinical and immunological events including Clinical Biopsy Proven Acute Rejection [C-BPAR], long-term kidney function and death censored graft loss over a median follow-up of five years. Episodes of C-BPAR were noted at a median of two years post-transplant. Adjusted odds of having a subsequent C-BPAR was significantly higher in the SCI-T group [SC-BLR and SC-TCMR] compared to NSI 3.8 (2.1-7.5). The adjusted hazard for death censored graft loss was significantly higher with SCI-T compared to NSI [1.99 (1.04-3.84)]. Overall, SCI detected through surveillance biopsy within the first year post-transplant is a harbinger for subsequent immunological events and is associated with a significantly greater hazard for subsequent C-BPAR and death censored graft loss. Thus, our study highlights the need for identifying patients with SCI through surveillance biopsy and develop strategies to prevent further alloimmune injuries.
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