Subclinical rejection in tacrolimus-treated renal transplant recipients.
BACKGROUND
Subclinical rejection, defined as histologic acute rejection in the absence of graft dysfunction, has been suggested as a cause of chronic allograft rejection. In cyclosporine-treated patients, the incidence of subclinical rejection 3 months after transplant is reported to be approximately 30%. The intent of our study was to determine the incidence of subclinical rejection in tacrolimus-treated renal allograft recipients.


METHODS
We prospectively studied the incidence of subclinical rejection on surveillance biopsies performed 3 months after transplantation in 114 patients transplanted between September 1, 1998 and November 30, 2000. All patients received tacrolimus, mycophenolate mofetil, and prednisone, and 56% received antibody induction.


RESULTS
Subclinical rejection was detected in 2.6% of patients (3/114, 95% confidence interval 0.5-7.5%). Borderline changes were detected in 11% (12/114). Subclinical rejections were treated with bolus methylprednisolone.


CONCLUSIONS
The incidence of subclinical rejection early after kidney transplantation is extremely low in tacrolimus-treated patients in whom early rejections are aggressively treated, suggesting that surveillance biopsies may not be necessary with this regimen.
Gloor
James M
JM
Transplant Center, Mayo Foundation and Clinic, Rochester, Minnesota 55905, USA. gloor.james@mayo.edu
Cohen
Ari J
AJ
Lager
Donna J
DJ
Grande
Joseph P
JP
Fidler
Mary E
ME
Velosa
Jorge A
JA
Larson
Timothy S
TS
Schwab
Thomas R
TR
Griffin
Matthew D
MD
Prieto
Mikel
M
Nyberg
Scott L
SL
Sterioff
Sylvester
S
Kremers
Walter K
WK
Stegall
Mark D
MD
D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D016559:Tacrolimus