Significance of revised criteria for chronic active T cell–mediated rejection in the 2017 Banff classification: Surveillance by 1-year protocol biopsies for kidney transplantation
| Autor: | Kosuke Masutani, Akihiro Tsuchimoto, Kaneyasu Nakagawa, Toshiaki Nakano, Kohei Unagami, Takanari Kitazono, Masayoshi Okumi, Yasuhiro Okabe, Masafumi Nakamura, Kazunari Tanabe, Yuta Matsukuma, Yoichi Kakuta, Kenji Ueki |
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| Rok vydání: | 2021 |
| Předmět: |
Graft Rejection
medicine.medical_specialty Biopsy T-Lymphocytes Urology 030230 surgery Kidney Nephropathy 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine medicine Humans Immunology and Allergy Pharmacology (medical) Survival analysis Kidney transplantation Transplantation Creatinine medicine.diagnostic_test business.industry Graft Survival Hazard ratio Reproducibility of Results medicine.disease Kidney Transplantation Confidence interval Tacrolimus chemistry business |
| Zdroj: | American Journal of Transplantation. 21:174-185 |
| ISSN: | 1600-6135 |
| DOI: | 10.1111/ajt.16093 |
| Popis: | Diagnostic criteria for chronic active T cell-mediated rejection (CA-TCMR) were revised in the Banff 2017 consensus, but it is unknown whether the new criteria predict graft prognosis of kidney transplantation. We enrolled 406 kidney allograft recipients who underwent a 1-year protocol biopsy (PB) and investigated the diagnostic significance of Banff 2017. Interobserver reproducibility of the 3 diagnosticians showed a substantial agreement rate of 0.68 in Fleiss's kappa coefficient. Thirty-three patients (8%) were classified as CA-TCMR according to Banff 2017, and 6 were previously diagnosed as normal, 12 as acute TCMR, 10 with borderline changes, and 5 as CA-TCMR according to Banff 2015 criteria. Determinant factors of CA-TCMR were cyclosporine use (vs tacrolimus), previous acute rejection, and BK polyomavirus-associated nephropathy. In survival analysis, the new diagnosis of CA-TCMR predicted a composite graft endpoint defined as doubling serum creatinine or death-censored graft loss (log-rank test, P < .001). In multivariate analysis, CA-TCMR was associated with the second highest risk of the composite endpoint (hazard ratio: 5.42; 95% confidence interval, 2.02-14.61; P < .001 vs normal) behind antibody-mediated rejection. In conclusion, diagnosis of CA-TCMR in Banff 2017 may facilitate detecting an unfavorable prognosis of kidney allograft recipients who undergo a 1-year PB. |
| Databáze: | OpenAIRE |
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