Early subclinical rejection treated with low dose i.v. steroids is not associated to graft survival impairment: 13-years' experience at a single center
| Autor: | Renzo Bonofiglio, Rosita Greco, Danilo Lofaro, Teresa Papalia, Donatella Vizza, Francesco Romeo, Francesca Leone, Simona Lupinacci, Giuseppina Toteda, Paolo Gigliotti, Massimino Senatore, Antonella La Russa, Roberto De Stefano, Anna Perri |
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| Rok vydání: | 2015 |
| Předmět: |
Nephrology
Adult Graft Rejection Male medicine.medical_specialty 030232 urology & nephrology Delayed Graft Function 030230 surgery behavioral disciplines and activities Gastroenterology 03 medical and health sciences 0302 clinical medicine Chronic allograft nephropathy Adrenal Cortex Hormones Internal medicine Biopsy medicine Humans Kidney transplantation Proportional Hazards Models Retrospective Studies medicine.diagnostic_test Proportional hazards model business.industry Hazard ratio Graft Survival Odds ratio Middle Aged medicine.disease Kidney Transplantation Surgery Transplantation Female business |
| Zdroj: | Journal of nephrology. 29(3) |
| ISSN: | 1724-6059 |
| Popis: | Subclinical rejection (SCR) has been variably associated with reduced graft survival, development and progression of interstitial fibrosis/tubular atrophy and chronic allograft nephropathy, but data are controversial concerning SCR treatment in terms of graft survival improvement. In this single-center retrospective study, we enrolled 174 adult kidney transplant recipients with a protocol biopsy performed at 30 days after transplantation to evaluate the incidence rate and risk factors for early SCR and its impact on 10-year graft survival. Five patients showed primary non function and were excluded. Among 159/169 (94.08 %) patients with stable graft function who underwent protocol biopsy, 17 (10.7 %) showed signs of SCR and were treated with low-dose intravenous (i.v.) steroids. Ten patients showed functional impairment, 8 (4.73 %) resulting as acute rejection. At multivariate analysis, donor age [odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.01–1.09], and delayed graft function (DGF) (OR 1.08, 95 % CI 1.03–1.12) were significantly associated with SCR. The 10-year graft survival rate in the SCR group was similar to that in the normal-findings group (76.5 vs. 74.9 % respectively; p = 0.61). At multivariate Cox regression, acute [hazard ratio (HR) 5.22, 95 % CI 1.70–16.01], but not sub-clinical, rejection was independently associated with long-term graft failure. In conclusion, early protocol biopsy is a useful and safe tool to detect early SCR which seems not to affect the long-term survival. We suggest that this could be, probably, linked to early SCR treatment with low dose i.v. steroids. |
| Databáze: | OpenAIRE |
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