title: Long-term impact of subclinical inflammation diagnosed by protocol biopsy one year after renal transplantation.
abstract: The long-term impact of subclinical acute rejection (SCAR) on renal graft function remains poorly understood. Furthermore, the interpretation of borderline lesions is difficult and their incidence is variable. The aim of this study was to analyze the characteristics of subclinical inflammation (SCI) in protocol biopsies performed 1-year after renal transplantation. SCI was defined as the presence of borderline lesions or SCAR according to the Banff 2005 classification. The patients included were a subpopulation of the CONCEPT study in which patients were randomized 3 months after transplantation to receive either sirolimus (SRL) or cyclosporine A (CsA) in combination with mycophenolate mofetil. At 1 year, we observed SCI in 37 of the 121 patients observed with an evaluable biopsy. The incidence was more frequent in the SRL group (SRL 45.2% vs. CsA 15.3%). At 30 months , SCI was associated with a significantly lower level of estimated glomerular filtration rate (mean MDRD 50.8 [±13.3] vs. 57.7 [±16.3] mL/min/1.73 m(2) , p = 0.035). In conclusion, SCI at 1-year posttransplantation is associated with worsening renal function and is more frequent in SRL-treated patients. Therefore, evaluation of SCI may be a valuable tool to allow the optimization of immunosuppressive regimens.
authors: Department of Nephrology and Transplantation, University Hospital, Poitiers, France. a.thierry@chu-poitiers.fr
authors: A
authors: A
authors: Thierry
authors: E
authors: E
authors: Thervet
authors: V
authors: V
authors: Vuiblet
authors: J-M
authors: JM
authors: Goujon
authors: M-C
authors: MC
authors: Machet
authors: L-H
authors: LH
authors: Noel
authors: N
authors: N
authors: Rioux-Leclercq
authors: F
authors: F
authors: Comoz
authors: C
authors: C
authors: Cordonnier
authors: A
authors: A
authors: François
authors: L
authors: L
authors: Marcellin
authors: S
authors: S
authors: Girardot-Seguin
authors: G
authors: G
authors: Touchard
mesh_terms: D001706:Biopsy; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007249:Inflammation / Q000175:diagnosis* / Q000473:pathology; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology; D016030:Kidney Transplantation; D016019:Survival Analysis
chemical_list: D007166:Immunosuppressive Agents