title: Impact of subclinical inflammation on the development of interstitial fibrosis and tubular atrophy in kidney transplant recipients.
abstract: Our aim was to study the impact of subclinical inflammation on the development of interstitial fibrosis and tubular atrophy (IF/TA) on a 1-year protocol biopsy in patients on rapid steroid withdrawal (RSW). A total of 256 patients were classified based on protocol biopsy findings at months 1 or 4. Group 1 is 172 patients with no inflammation, group 2 is 50 patients with subclinical inflammation (SCI), group 3 is 19 patients with subclinical acute rejection (SAR) and group 4 is 15 patients with clinical acute rejection (CAR). On the 1-year biopsy, more patients in group 2 (SCI) (34%, p = 0.004) and group 3 (SAR) (53%, p = 0.0002), had an IF/TA score > 2 compared to group 1 (control) (15%). IF/TA was not increased in group 4 (CAR) (20%). The percent with IF/TA score > 2 and interstitial inflammation (Banff i score > 0) was higher in group 2 (16%, p = 0.004) and group 3 (37%, p < 0.0001) compared to group 1 (3%). In a multivariate analysis, patients in groups 2 or 3 had a higher risk of IF/TA score > 2 on the 1-year biopsy (OR 6.62, 95% CI 2.68-16.3). We conclude that SCI and SAR increase the risk of developing IF/TA in patient on RSW.
authors.affiliation: Department of Medicine, Mayo Clinic Arizona, Phoenix, AZ. Heilman.raymond@mayo.edu
authors.forename: R L
authors.initials: RL
authors.lastname: Heilman
authors.forename: Y
authors.initials: Y
authors.lastname: Devarapalli
authors.forename: H A
authors.initials: HA
authors.lastname: Chakkera
authors.forename: K L
authors.initials: KL
authors.lastname: Mekeel
authors.forename: A A
authors.initials: AA
authors.lastname: Moss
authors.forename: D C
authors.initials: DC
authors.lastname: Mulligan
authors.forename: M J
authors.initials: MJ
authors.lastname: Mazur
authors.forename: K
authors.initials: K
authors.lastname: Hamawi
authors.forename: J W
authors.initials: JW
authors.lastname: Williams
authors.forename: K S
authors.initials: KS
authors.lastname: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000209:etiology*; D001706:Biopsy; D005260:Female; D005355:Fibrosis / Q000209:etiology*; D006084:Graft Rejection; D006801:Humans; D007249:Inflammation; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D007684:Kidney Tubules / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016896:Treatment Outcome