Histological outcome of acute cellular rejection in kidney transplantation after treatment with methylprednisolone.
BACKGROUND
Several studies comparing the response of acute cellular rejection (ACR) episodes to different corticosteroid regimens have been conducted. However, in most of them, the histological evaluation of the infiltrate and its correlation with clinical response was not studied. The clinical and histological outcomes of 37 episodes of ACR treated with methylprednisolone (MP) were studied, with the aim to determine how long the infiltrate takes to be cleared after therapy.


METHODS
A total of 37 patients with biopsy-proven ACR were treated with 8 or 16 mg of MP/kg/day. Allograft biopsies were repeated at 5 and 10 days after the end of corticotherapy. Clinical and histological outcomes were compared.


RESULTS
Six patients were excluded; 15 (48.4%) patients responded to therapy; the mean serum creatinine of these patients reached normal levels in the 2 weeks that followed treatment. Nine patients (60%) of this group had signs of ACR on biopsies done 5 days after corticotherapy, and four (26.7%) maintained them on the 10th day. Among 16 patients with no clinical response, none reached normal serum creatinine levels; 15 (93.7%) had signs of rejection 5 days after treatment and maintained them on the 10th day. Histological signs of ACR disappeared in 73.3% of patients with clinical response 10 days after therapy, but in only 6.3% of patients with no response (P=0.001).


CONCLUSIONS
Biopsies performed 5 days after treatment show a high incidence of features of ACR; such features take on average 10 days to disappear in nearly 75% of cases with successful therapy with MP.
Division of Urology, Clínicas Hospital, University of São Paulo Medical School, Brazil.
E
E
Mazzucchi
A M
AM
Lucon
W C
WC
Nahas
E D
ED
Neto
L B
LB
Saldanha
E
E
Sabbaga
L E
LE
Ianhez
S
S
Arap
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016572:Cyclosporine / Q000627:therapeutic use*; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology / Q000502:physiology; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008775:Methylprednisolone