Correlation of histology to clinical rejection reversal: a thymoglobulin multicenter trial report.
Correlation of histology to rejection reversal: A Thymoglobulin Multicenter Trial report


BACKGROUND
Histology may provide a link between clinical response to antirejection therapy and graft function. In a subset of centers, renal biopsy was a secondary end point for the Thymoglobulin Multicenter Trial.


METHODS
Thirty-eight patients had a protocol biopsy one to two weeks following the end of therapy. Inclusion and post-treatment biopsies were graded and scored according to Banff criteria by a central pathologist who was blinded to the type and outcome of therapy and the timing of the biopsy.


RESULTS
The majority of patients (31 of 38) had moderate rejection on their inclusion biopsy. An improvement of at least one Banff grade occurred in 58% of the patients. The treatment was clinically successful in 33 patients, but two thirds of the patients (25 out of 38) demonstrated residual inflammation in the graft. The degree of improvement of inflammation was proportionate to rejection severity (P = 0.006). Banff scoring indicated that residual inflammation was less in Thymoglobulin-treated patients than in those receiving Atgam (P < 0.05) and correlated with the incidence of recurrent rejection (P = 0.015).


CONCLUSIONS
These data demonstrate a discrepancy between clinical and histological resolution of acute renal allograft rejection. Residual infiltrates in the graft following rejection therapy are common and, despite clinical improvement, may indicate an increased risk for recurrent rejection.
Gaber
L W
LW
The University of Tennessee-Memphis, USA. lgaber@utmem1.utmem.edu
Moore
L W
LW
Gaber
A O
AO
Tesi
R J
RJ
Meyer
J
J
Schroeder
T J
TJ
D000208:Acute Disease; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001706:Biopsy; D004311:Double-Blind Method; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged
D000961:Antilymphocyte Serum