title: Sensitization, pathologic, and imaging findings comparing symptomatic and quiescent failed renal allografts.
abstract: Late allograft failure (LAF) is a common cause of end stage renal disease. These patients face interrelated challenges regarding immunosuppression management, risk of graft intolerance syndrome (GIS), and sensitization. This retrospective study analyzes sensitization, pathology, imaging, and transfusion requirements in 33 LAFs presenting either with GIS (22) or grafts remaining quiescent (11). All patients underwent immunosuppression weaning to discontinuation at LAF. Profound increases in sensitization were noted for all groups and occurred in the GIS group prior to transplant nephrectomy (TxN). Patients with GIS experienced a major upswing in sensitization at, or before the time of their symptomatic presentation. For both GIS and quiescent grafts, sensitization appeared to be closely linked to immunosuppression withdrawal. Most transfusion naïve patients became highly sensitized. Fourteen patients in the GIS group underwent TxN which revealed grade II acute cellular rejection or worse, with grade 3 chronic active T-cell-mediated rejection. Blinded comparisons of computed tomography scan of GIS group revealed swollen allografts with fluid collections compared with the quiescent allografts (QAs), which were shrunken and atrophic. The renal volume on imaging and weight of explants nearly matched. Future studies should focus on interventions to avoid sensitization and GIS.
authors.affiliation: Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Singh
authors.forename: Rick I
authors.initials: RI
authors.lastname: Feld
authors.forename: Beth W
authors.initials: BW
authors.lastname: Colombe
authors.forename: John L
authors.initials: JL
authors.lastname: Farber
authors.forename: Jay H
authors.initials: JH
authors.lastname: Herman
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gulati
authors.forename: Warren R
authors.initials: WR
authors.lastname: Maley
authors.forename: Adam M
authors.initials: AM
authors.lastname: Frank
mesh_terms: D003952:Diagnostic Imaging; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents
keywords: graft intolerance syndrome; late allograft failure; sensitization; transplant nephrectomy