title: Early subclinical rejection treated with low dose i.v. steroids is not associated to graft survival impairment: 13-years' experience at a single center.
abstract: Subclinical rejection (SCR) has been variably associated with reduced graft survival, development and progression of interstitial fibrosis/tubular atrophy and chronic allograft nephropathy, but data are controversial concerning SCR treatment in terms of graft survival improvement. In this single-center retrospective study, we enrolled 174 adult kidney transplant recipients with a protocol biopsy performed at 30 days after transplantation to evaluate the incidence rate and risk factors for early SCR and its impact on 10-year graft survival. Five patients showed primary non function and were excluded. Among 159/169 (94.08 %) patients with stable graft function who underwent protocol biopsy, 17 (10.7 %) showed signs of SCR and were treated with low-dose intravenous (i.v.) steroids. Ten patients showed functional impairment, 8 (4.73 %) resulting as acute rejection. At multivariate analysis, donor age [odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.01-1.09], and delayed graft function (DGF) (OR 1.08, 95 % CI 1.03-1.12) were significantly associated with SCR. The 10-year graft survival rate in the SCR group was similar to that in the normal-findings group (76.5 vs. 74.9 % respectively; p = 0.61). At multivariate Cox regression, acute [hazard ratio (HR) 5.22, 95 % CI 1.70-16.01], but not sub-clinical, rejection was independently associated with long-term graft failure. In conclusion, early protocol biopsy is a useful and safe tool to detect early SCR which seems not to affect the long-term survival. We suggest that this could be, probably, linked to early SCR treatment with low dose i.v. steroids.
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gigliotti
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Lofaro
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Leone
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Papalia
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Massimino
authors.initials: M
authors.lastname: Senatore
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Rosita
authors.initials: R
authors.lastname: Greco
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Perri
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Vizza
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Lupinacci
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Toteda
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: La Russa
authors.affiliation: Department of Anatomic Pathology, Annunziata Hospital, Cosenza, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: De Stefano
authors.affiliation: Department of Anatomic Pathology, Annunziata Hospital, Cosenza, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Romeo
authors.affiliation: "Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy. rbonofi@gmail.com.
authors.forename: Renzo
authors.initials: R
authors.lastname: Bonofiglio
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Graft survival; Kidney transplantation; Steroids; Subclinical rejection