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.
Transplant Center, Mayo Foundation and Clinic, Rochester, Minnesota 55905, USA. gloor.james@mayo.edu
James M
JM
Gloor
Ari J
AJ
Cohen
Donna J
DJ
Lager
Joseph P
JP
Grande
Mary E
ME
Fidler
Jorge A
JA
Velosa
Timothy S
TS
Larson
Thomas R
TR
Schwab
Matthew D
MD
Griffin
Mikel
M
Prieto
Scott L
SL
Nyberg
Sylvester
S
Sterioff
Walter K
WK
Kremers
Mark D
MD
Stegall
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