title: Immuno-histological assessment of sub-clinical acute and borderline rejection in renal allograft recipients: Data from a transplant center in India.
abstract: This single-center study was carried out on living related and unrelated renal transplant recipients (RTRs) to evaluate the usefulness of surveillance biopsies in monitoring stable renal allografts using immuno-histological markers for immune-activation. This is a prospective, longitudinal study. Protocol biopsies of 60 RTRs with stable graft function were evaluated at three, six and 12 months post-transplant. Immuno-histological evaluation was carried out using immune-activation markers (perforins, granzyme and interleukin-2R), phenotypic markers (CD-3 and CD-20), viral markers and C4d. The demographic and clinical profile was recorded for each patient. All cases of acute sub-clinical rejection (SCR) were treated and borderline SCR cases were followed-up without treatment. SCR at three and six months post-transplant was evident in 16.7% and 3.7% of RTRs, respectively. Positive statistical association of SCR was seen with HLA-DR mismatches, whereas patients receiving induction therapy and tacrolimus-based immunosuppression exhibited a lower incidence of SCR. T cell phenotype with persistent expression of immune-activation markers exhibited positive statistical association with interstitial fibrosis and tubular atrophy at 12-month follow-up biopsy. The mean creatinine levels were significantly lower in the protocol biopsy group than the non-protocol biopsy group. No significant difference was found between the mean creatinine levels of the SCR group after treatment and the non-SCR cases within the protocol biopsy group. Early treatment of sub-clinical acute rejection leads to better functional outcomes. However, persistent immune-activation is associated with chronicity and may have implications on long-term graft survival.
authors.affiliation: Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India.
authors.forename: Sonia
authors.initials: S
authors.lastname: Badwal
authors.forename: Arun
authors.initials: A
authors.lastname: Kumar
authors.forename: A K
authors.initials: AK
authors.lastname: Hooda
authors.forename: P P
authors.initials: PP
authors.lastname: Varma
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007194:India; D007668:Kidney / Q000276:immunology* / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D055815:Young Adult
chemical_list: D003404:Creatinine