J Korean Surg Soc.  2012 Dec;83(6):343-351. 10.4174/jkss.2012.83.6.343.

Chronic allograft injury by subclinical borderline change: evidence from serial protocol biopsies in kidney transplantation

• Min SI
• Park YS
• Ahn S
• Park T
• Park DD
• Kim SM
• Moon KC
• Min SK
• Kim YS
• Ahn C
• Kim SJ
• Ha J

• KMID: 1437529
• DOI: http://doi.org/10.4174/jkss.2012.83.6.343

Abstract

PURPOSE
This study investigated the impact of subclinical borderline changes on the development of chronic allograft injury in patients using a modern immunosuppression protocol.
METHODS
Seventy patients with stable renal allograft function and who underwent protocol biopsies at implantation, 10 days and 1 year after transplantation were included and classified based on biopsy findings at day 10. The no rejection (NR) group included 33 patients with no acute rejection. The treatment (Tx) group included 21 patients with borderline changes following steroid pulse therapy, and the nontreatment (NTx) group included 16 patients with borderline changes nontreated.
RESULTS
The Banff Chronicity Score (BChS) and modified BChS (MBChS) were not different among the three groups at implantation (P = 0.48) or on day 10 (P = 0.96). Surprisingly, the NTx group had more prominent chronic scores at the 1-year biopsy, including BChS (3.07 +/- 1.33, P = 0.005) and MBChS (3.14 +/- 1.41, P = 0.008) than those in the Tx and NR group, and deterioration of BChS was more noticeable in the NTx group (P = 0.037), although renal function was stable (P = 0.66). No difference in chronic injury scores was observed between the Tx and NR groups at the 1-year biopsy.
CONCLUSION
Subclinical borderline changes can be a risk factor for chronic allograft injury and should be considered for antirejection therapy.

Keyword

Borderline change; Chronic allograft injury; Kidney transplantation; Protocol kidney biopsy; Steroid pulse therapy

MeSH Terms

Biopsy
Cyclohexylamines
Humans
Immunosuppression
Kidney
Kidney Transplantation
Rejection (Psychology)
Risk Factors
Transplantation, Homologous
Transplants
Cyclohexylamines

Figure

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  Fig. 1 Changes in mean tacrolimus (TAC) trough levels. NR, no rejection; Tx, treatment; NTx, nontreatment.

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  Fig. 2 Changes in renal allograft function. Graft function was not influenced and maintained stable until 1-year, regardless of borderline changes at the 10-day protocol biopsy and whether those borderline changes were treated with steroid pulse therapy or not. NR, no rejection; Tx, treatment; NTx, nontreatment; eGFR, estimated glomerular filtration rate.

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  Fig. 3 Changes in chronic injury scores between protocol biopsies. BChS, Banff Chronicity Score; MBChS, modified Banff Chronicity Score; TVDS, Transplant Vascular Damage Score; 0-D, at implantation; 10-D, at 10-day protocol biopsy; 1-Y, at 1 year protocol biopsy. *P < 0.01. †P > 0.05. ‡P < 0.05.

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  Fig. 4 Comparison of chronic injury scores at the 1-year protocol biopsies. The nontreatment (NTx) group showed high chronic injury scores on all assessments and the treatment (Tx) group showed comparable scores with those of the no rejection (NR) group. BChS, Banff Chronicity Score; MBChS, modified Banff Chronicity Score; TVDS, Transplant Vascular Damage Score. *P < 0.01. †P > 0.05. ‡P < 0.05.

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  Fig. 5 Changes in chronic injury scores (dBChS, dMBChS and dTVDS) calculated by subtracting the 1-year protocol biopsy scores from the 10-day protocol biopsy scores. BChS, Banff Chronicity Score; MBChS, modified Banff Chronicity Score; TVDS, Transplant Vascular Damage Score; NTx, nontreatment; Tx, treatment; NR, no rejection. *P < 0.01. †P > 0.05. ‡P < 0.05.

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