title: Subclinical rejection in stable positive crossmatch kidney transplant patients: incidence and correlations.
abstract: We reviewed 116 surveillance biopsies obtained approximately 1, 3, 6 and 12 months posttransplantation from 50 +XM live donor kidney transplant recipients to determine the frequency of subclinical cell-mediated rejection (CMR) and antibody-mediated rejection (AMR). Subclinical CMR was present in 39.7% of the biopsies at 1 month and >20% at all other time points. The presence of diffuse C4d on biopsies obtained at each time interval ranged from 20 to 30%. In every case, where histological and immunohistological findings were diagnostic for AMR, donor-specific antibody was found in the blood, challenging the long-held belief that low-level antibody could evade detection due to absorption on the graft. Among clinical factors, only recipient age was associated with subclinical CMR. Clinical factors associated with subclinical AMR were recipient age, positive cytotoxic crossmatch prior to desensitization and two mismatches of HLA DR 51, 52 and 53 alleles. Surveillance biopsies during the first year post-transplantation for these high-risk patients uncover clinically occult processes and phenotypes, which without intervention diminish allograft survival and function.
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. ekraus2@jhmi.edu
authors.forename: E S
authors.initials: ES
authors.lastname: Kraus
authors.forename: R S
authors.initials: RS
authors.lastname: Parekh
authors.forename: P
authors.initials: P
authors.lastname: Oberai
authors.forename: D
authors.initials: D
authors.lastname: Lepley
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
authors.forename: S
authors.initials: S
authors.lastname: Bagnasco
authors.forename: V
authors.initials: V
authors.lastname: Collins
authors.forename: M
authors.initials: M
authors.lastname: Leffell
authors.forename: D
authors.initials: D
authors.lastname: Lucas
authors.forename: H
authors.initials: H
authors.lastname: Rabb
authors.forename: L C
authors.initials: LC
authors.lastname: Racusen
authors.forename: A L
authors.initials: AL
authors.lastname: Singer
authors.forename: Z A
authors.initials: ZA
authors.lastname: Stewart
authors.forename: D S
authors.initials: DS
authors.lastname: Warren
authors.forename: A A
authors.initials: AA
authors.lastname: Zachary
authors.forename: M
authors.initials: M
authors.lastname: Haas
authors.forename: R A
authors.initials: RA
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000483:Alleles; D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology*; D006684:HLA-DR Antigens / Q000235:genetics / Q000276:immunology; D059845:HLA-DRB4 Chains; D059847:HLA-DRB5 Chains; D006650:Histocompatibility Testing / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000473:pathology / Q000502:physiology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006684:HLA-DR Antigens; C050610:HLA-DR53; D059845:HLA-DRB4 Chains; D059847:HLA-DRB5 Chains; D003404:Creatinine