title: Designation of T-cell-mediated rejection type Ib and IIa reflects the type of rejection rather than the severity in the Banff classification.
abstract: OBJECTIVE
  Whether T-cell-mediated rejection Banff classification type Ib (severe tubulointerstitial rejection) and type IIa (mild vascular rejection) are associated with responses to antirejection therapy and long-term graft survival are unclear.
  
  
  METHODS
  One hundred ten patients were enrolled who had at least 1 episode of T-cell-mediated rejection and whose highest T-cell-mediated rejection severity was T-cell-mediated rejection type Ib or IIa.
  
  
  RESULTS
  T-cell-mediated rejection Ib occurred significantly later than T-cell-mediated rejection IIa (P < .001). The proportion of partial/no response to antirejection therapy was comparable between the 2 groups (P = .83). Up to 8-year posttransplant, death-censored graft survival rate of the T-cell-mediated rejection Ib group was similar to that of the T-cell-mediated rejection IIa group (P = .51). Early T-cell-mediated rejection IIa had a statistically higher death-censored graft survival rate than did late T-cell-mediated rejection IIa (P < .001), while no significant difference in the death-censored graft survival was found between early and late T-cell-mediated rejection Ib (P = .11) or between early T-cell-mediated rejection Ib and early T-cell-mediated rejection IIa (P = .11) or between late T-cell-mediated rejection Ib and late T-cell-mediated rejection IIa (P = .07). Furthermore, the T-cell-mediated rejection IIa with isolated v1 lesion (v1, i0-1, t0-1) showed a similar death-censored graft survival rate compared to T-cell-mediated rejection IIa with intensive tubulointerstitial inflammation (v1, i2-3, t2-3). The timing of rejection, graft number, the number of indicated biopsies and the presence of ci/ct lesions were associated with long-term graft loss.
  
  
  CONCLUSIONS
  The designation of T-cell-mediated rejection type Ib and IIa reflects the different type rather than the distinct severity of rejection and has no independent prognostic significance.
authors.affiliation: From the Medizinische Klinik mit Schwerpunkt Nephrologie, Berlin, Germany.
authors.forename: Kaiyin
authors.initials: K
authors.lastname: Wu
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.forename: Danilo
authors.initials: D
authors.lastname: Schmidt
authors.forename: Hans-Hellmut
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Birgit
authors.initials: B
authors.lastname: Rudolph
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects / Q000276:immunology* / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009395:Nephritis, Interstitial / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents