Study of acute antibody-mediated rejection in renal allograft biopsies.
BACKGROUND
Acute B-cell-mediated rejection (AMR) was ill-defined until the 6(th) Banff meeting establishing the criteria. We performed a retrospective analysis of renal allograft biopsies to evaluate immune injury with reference to the Ahmedabad Tolerance Induction Protocols (ATIP).


METHODS
We evaluated renal allograft biopsies belonging to 3 groups: group A patients (n = 120) underwent a modified ATIP with addition of mesenchymal stem cells, anti-B-cell antibodies, and higher target-specific irradiation; group B patients (n = 351) belong to the old ATIP; and group C (n = 142) were controls who opted out of ATIP. The majority were biopsied 2 or 3 times. Biopsies were subdivided: <or=60 days, 61 to 180 days, or 181 to 365 days' posttransplant. We compared demographics and diagnoses per the modified Banff criteria.


RESULTS
At <or=60 days' posttransplantation, acute T-cell-mediated rejection (ATIR) was noted in 1.7% of group A patients; 5.98% of B; 33.8% of C with AMR in 11.7% of A; 10.8% of B; and 24.6% of C. At 61 to 180 days' posttransplant, ATIR was absent in group A, 1.99% in group B, and 21.83% in controls, whereas AMR was absent in group A; 1.7% in group B; and 39.4% of controls. At 181 to 365 days, ATIR and AMR were absent in group A; ATIR was 0.56% in group B and 14.1% in controls; AMR was 0.85% in group B and 21.1% in controls. The immunosuppression included cyclosporine (mg/kgBW/day) was 1.5 +/- 0.1 in group A; 2 +/- 0.5 in group B; and prednisone (mg/kgBW/day), 0.15 in group A, 0.2 in group B. The controls received standard doses.


CONCLUSIONS
The modified ATIP has reduced immunosuppressive drug dose requirements and lessened ATIR; however, AMR, although significantly less than controls, needs to be addressed.
Department of Pathology, Laboratory Medicine, Transfusion Services, and Immunohematology, G.R. Doshi and K.M. Mehta Institute of Kidney diseases and Research Centre, Ahmedabad, India. ikdrcad1@sancharnet.in
K V
KV
Kanodia
A V
AV
Vanikar
H L
HL
Trivedi
D000293:Adolescent; D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology; D001706:Biopsy; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D016559:Tacrolimus / Q000627:therapeutic use; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016572:Cyclosporine; D016559:Tacrolimus; D008775:Methylprednisolone