title: Significance of subclinical rejection in early renal allograft biopsies for chronic allograft dysfunction.
abstract: To determine the significance of early subclinical rejection of renal allografts, we reviewed 127 biopsy specimens obtained soon after transplantation. Histological finding was categorized according to a modification of the Banff scheme as: acute rejection (AR), borderline changes (BL); non-specific inflammatory changes, (NI) and no rejection (NR). Subclinical rejection was defined as AR, BL or NI. Patients with BL or NI were divided into two groups; one was treated with high-dose methylprednisolone (MP), the other remained untreated. Freedom from chronic allograft dysfunction (defined as non-doubling of serum creatinine 5 yr after transplantation) was significantly more frequent in the NR group (89%) than in the BL (70%) and AR (64%) groups. At 1 yr after transplantation, mean serum creatinine had increased significantly only in the untreated group (p < 0.05), and re-biopsy showed that interstitial fibrosis had developed to a significantly greater extent in the untreated group than in the treated group (p < 0.01). Subclinical rejection in the early protocol biopsies correlated closely with subsequent allograft dysfunction. High-dose MP treatment for early subclinical rejection may be effective in suppressing the development of interstitial fibrosis at 1 yr after transplantation.
authors: Department of Nephrology, Toho University, Tokyo, Japan. moriaz@kdr.biglobe.ne.jp
authors: Moriatsu
authors: M
authors: Miyagi
authors: Yukio
authors: Y
authors: Ishikawa
authors: Sonoo
authors: S
authors: Mizuiri
authors: Atsushi
authors: A
authors: Aikawa
authors: Takehiro
authors: T
authors: Ohara
authors: Akira
authors: A
authors: Hasegawa
mesh_terms: D000328:Adult; D001706:Biopsy; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D005355:Fibrosis; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D008297:Male
chemical_list: D003404:Creatinine