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How Should Acute T-cell Mediated Rejection of Kidney Transplants Be Treated: Importance of Follow-up Biopsy

BACKGROUND. Limited published data exist to guide patient monitoring after the treatment of T-cell mediated rejection (TCMR) of kidney allografts. METHODS. We reviewed the kidney function and histological outcomes after treatment of 163 first episodes of biopsy-proven TCMR between January 1‚ 2015‚ a...

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Autores principales: Aziz, Fahad, Parajuli, Sandesh, Garg, Neetika, Mohamed, Maha, Zhong, Weixiong, Djamali, Arjang, Mandelbrot, Didier
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8963842/
https://www.ncbi.nlm.nih.gov/pubmed/35372674
http://dx.doi.org/10.1097/TXD.0000000000001305
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author Aziz, Fahad
Parajuli, Sandesh
Garg, Neetika
Mohamed, Maha
Zhong, Weixiong
Djamali, Arjang
Mandelbrot, Didier
author_facet Aziz, Fahad
Parajuli, Sandesh
Garg, Neetika
Mohamed, Maha
Zhong, Weixiong
Djamali, Arjang
Mandelbrot, Didier
author_sort Aziz, Fahad
collection PubMed
description BACKGROUND. Limited published data exist to guide patient monitoring after the treatment of T-cell mediated rejection (TCMR) of kidney allografts. METHODS. We reviewed the kidney function and histological outcomes after treatment of 163 first episodes of biopsy-proven TCMR between January 1‚ 2015‚ and July 31‚ 2020. RESULTS. Of the 146 patients treated with steroid pulse alone, complete histological response was seen in 83% of patients with borderline rejection, 82.5% with grade 1A, 67% with grade 1B, and 50% with grade IIA. Of the 17 patients treated with steroids plus antithymocyte globulin, the complete histological response rate was 100% with grade 1A, 75% with grade 1B, 100% with grade IIA, and 57% with grade IIB. Among the patients with complete response as assessed by kidney function, 14% only had a partial or no response histologically. Among patients with no kidney function response, 68% had a complete response histologically. CONCLUSION. We thus find that responses based on kidney function alone do not correlate well with histological responses. If further treatment had been based solely on changes in estimated glomerular filtration rate, a significant number of patients would have been subsequently undertreated or overtreated. These results support the use of protocol follow-up biopsies after the treatment of TCMR.
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spelling pubmed-89638422022-03-31 How Should Acute T-cell Mediated Rejection of Kidney Transplants Be Treated: Importance of Follow-up Biopsy Aziz, Fahad Parajuli, Sandesh Garg, Neetika Mohamed, Maha Zhong, Weixiong Djamali, Arjang Mandelbrot, Didier Transplant Direct Kidney Transplantation BACKGROUND. Limited published data exist to guide patient monitoring after the treatment of T-cell mediated rejection (TCMR) of kidney allografts. METHODS. We reviewed the kidney function and histological outcomes after treatment of 163 first episodes of biopsy-proven TCMR between January 1‚ 2015‚ and July 31‚ 2020. RESULTS. Of the 146 patients treated with steroid pulse alone, complete histological response was seen in 83% of patients with borderline rejection, 82.5% with grade 1A, 67% with grade 1B, and 50% with grade IIA. Of the 17 patients treated with steroids plus antithymocyte globulin, the complete histological response rate was 100% with grade 1A, 75% with grade 1B, 100% with grade IIA, and 57% with grade IIB. Among the patients with complete response as assessed by kidney function, 14% only had a partial or no response histologically. Among patients with no kidney function response, 68% had a complete response histologically. CONCLUSION. We thus find that responses based on kidney function alone do not correlate well with histological responses. If further treatment had been based solely on changes in estimated glomerular filtration rate, a significant number of patients would have been subsequently undertreated or overtreated. These results support the use of protocol follow-up biopsies after the treatment of TCMR. Lippincott Williams & Wilkins 2022-03-25 /pmc/articles/PMC8963842/ /pubmed/35372674 http://dx.doi.org/10.1097/TXD.0000000000001305 Text en Copyright © 2022 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Kidney Transplantation
Aziz, Fahad
Parajuli, Sandesh
Garg, Neetika
Mohamed, Maha
Zhong, Weixiong
Djamali, Arjang
Mandelbrot, Didier
How Should Acute T-cell Mediated Rejection of Kidney Transplants Be Treated: Importance of Follow-up Biopsy
title How Should Acute T-cell Mediated Rejection of Kidney Transplants Be Treated: Importance of Follow-up Biopsy
title_full How Should Acute T-cell Mediated Rejection of Kidney Transplants Be Treated: Importance of Follow-up Biopsy
title_fullStr How Should Acute T-cell Mediated Rejection of Kidney Transplants Be Treated: Importance of Follow-up Biopsy
title_full_unstemmed How Should Acute T-cell Mediated Rejection of Kidney Transplants Be Treated: Importance of Follow-up Biopsy
title_short How Should Acute T-cell Mediated Rejection of Kidney Transplants Be Treated: Importance of Follow-up Biopsy
title_sort how should acute t-cell mediated rejection of kidney transplants be treated: importance of follow-up biopsy
topic Kidney Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8963842/
https://www.ncbi.nlm.nih.gov/pubmed/35372674
http://dx.doi.org/10.1097/TXD.0000000000001305
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