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The severity of acute cellular rejection defined by Banff classification is associated with kidney allograft outcomes

Kaiyin Wu1, Klemens Budde, Huber Lu

  • 11 Medizinische Klinik mit Schwerpunkt Nephrologie, Charité Campus Mitte, Universitätsmedizin Berlin, Germany. 2 Institut für Pathologie, Charité Campus Mitte, Universitätsmedizin Berlin, Germany. 3 Address correspondence to: Dr. Birgit Rudolph, Institut für Pathologie, Charite Campus Mitte, Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.

Transplantation
|June 4, 2014
PubMed

Insights

Acute cellular rejection (ACR) severity and timing impact kidney transplant graft survival. Vascular or late ACR predicts poorer outcomes, while tubulointerstitial inflammation extent is not significant for vascular rejection prognosis.

Area of Science:

  • Nephrology
  • Transplant Immunology
  • Pathology

Background:

  • The association between acute cellular rejection (ACR) severity and timing, as defined by the 2009 Banff classification, and long-term graft survival remains unclear.
  • Understanding these factors is crucial for optimizing post-transplant management and improving patient outcomes.

Purpose of the Study:

  • To investigate the impact of ACR severity and timing on death-censored graft survival (DCGS) in kidney transplant recipients.
  • To identify specific histological features associated with poor graft survival.

Main Methods:

  • ACR severity was categorized into low (borderline), moderate (TCMR I - interstitial rejection), and high (TCMR II/III - vascular rejection).
  • Biopsies negative for donor-specific antibodies (DSA), C4d, and microcirculation changes were analyzed.
  • Early (≤6 months) and late (>6 months) ACR were defined, with a control group of patients without post-transplant biopsy.

Main Results:

  • All ACR groups showed significantly lower DCGS rates compared to controls (P<0.001).
  • Late ACR was associated with significantly poorer graft survival than early ACR (63.6% vs. 87.4%, P<0.001).
  • Intimal arteritis (Banff v-lesion) was an independent predictor of long-term graft loss, irrespective of ACR timing.

Conclusions:

  • All forms of ACR negatively affect long-term kidney transplant graft survival.
  • Vascular rejection and late-occurring ACR are particularly detrimental to graft survival.
  • The degree of tubulointerstitial inflammation does not significantly influence prognosis in vascular rejection.
Abstract

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