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

Area of Science:

• Nephrology
• Transplantation Immunology
• Pathology

Background:

• Chronic active T-cell-mediated rejection (CA-TCMR) is a significant concern in kidney transplantation.
• While treatment can improve CA-TCMR histology, its impact on long-term renal prognosis is not well-established.

Purpose of the Study:

• To investigate the association between the histological response to therapy for CA-TCMR and kidney allograft survival.
• To determine if persistent CA-TCMR after treatment predicts poorer graft outcomes.

Main Methods:

• Retrospective review of 37 patients diagnosed with CA-TCMR between 2018 and 2023.
• Categorization into persistent (11 patients) and transient (26 patients) CA-TCMR groups based on follow-up biopsies.
• Composite graft endpoint defined as a doubling of serum creatinine or end-stage kidney disease.

Main Results:

• No significant changes in serum creatinine, eGFR, or proteinuria were observed in either group post-treatment.
• The transient CA-TCMR group showed significant improvement in interstitial fibrosis and tubular atrophy (IFTA) and Banff scores.
• Persistent CA-TCMR was linked to significantly worse graft survival (p = 0.002) and increased risk after adjusting for clinical factors (HR: 11.4, p = 0.043).

Conclusions:

• Persistence of CA-TCMR histopathology post-treatment is a significant risk factor for kidney allograft loss.
• Transient CA-TCMR suggests a more favorable prognosis for allograft survival.