Chronic allograft injury by subclinical borderline change: evidence from serial protocol biopsies in kidney transplantation.
10.4174/jkss.2012.83.6.343
- Author:
Sang Il MIN
1
;
Young Suk PARK
;
Sanghyun AHN
;
Taejin PARK
;
Dae Do PARK
;
Suh Min KIM
;
Kyung Chul MOON
;
Seung Kee MIN
;
Yon Su KIM
;
Curie AHN
;
Sang Joon KIM
;
Jongwon HA
Author Information
1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. jwhamd@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Borderline change;
Chronic allograft injury;
Kidney transplantation;
Protocol kidney biopsy;
Steroid pulse therapy
- MeSH:
Biopsy;
Cyclohexylamines;
Humans;
Immunosuppression;
Kidney;
Kidney Transplantation;
Rejection (Psychology);
Risk Factors;
Transplantation, Homologous;
Transplants
- From:Journal of the Korean Surgical Society
2012;83(6):343-351
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This study investigated the impact of subclinical borderline changes on the development of chronic allograft injury in patients using a modern immunosuppression protocol. METHODS: Seventy patients with stable renal allograft function and who underwent protocol biopsies at implantation, 10 days and 1 year after transplantation were included and classified based on biopsy findings at day 10. The no rejection (NR) group included 33 patients with no acute rejection. The treatment (Tx) group included 21 patients with borderline changes following steroid pulse therapy, and the nontreatment (NTx) group included 16 patients with borderline changes nontreated. RESULTS: The Banff Chronicity Score (BChS) and modified BChS (MBChS) were not different among the three groups at implantation (P = 0.48) or on day 10 (P = 0.96). Surprisingly, the NTx group had more prominent chronic scores at the 1-year biopsy, including BChS (3.07 +/- 1.33, P = 0.005) and MBChS (3.14 +/- 1.41, P = 0.008) than those in the Tx and NR group, and deterioration of BChS was more noticeable in the NTx group (P = 0.037), although renal function was stable (P = 0.66). No difference in chronic injury scores was observed between the Tx and NR groups at the 1-year biopsy. CONCLUSION: Subclinical borderline changes can be a risk factor for chronic allograft injury and should be considered for antirejection therapy.
