Findings and Significance of Early Follow-Up Biopsies After Treatment of Acute Rejection in Kidney Transplant Recipients

Le résumé fourni par la source

Treatment resistant acute rejection after kidney transplantation is linked to inferior outcomes, yet many centers do not routinely perform follow-up biopsies. The optimal timing of such biopsies remains uncertain. We evaluated findings from follow-up biopsies performed ≤45 days after treatment of acute rejection and assessed their association with long-term outcomes. Adult kidney transplants performed from 01/2014 to 07/2024 were included (n = 2,420). Acute rejections were classified according to Banff criteria. T-cell-mediated rejection, including borderline TCMR changes, was treated with pulse steroids; antibody-mediated rejection was treated with steroids, intravenous immunoglobulin, and plasma exchange. Findings from follow-up biopsies taken ≤45 days after treatment of early acute rejection were correlated with graft outcomes. Of 383 patients (16%) with acute rejection within 3 months post-transplant, 221 underwent a follow-up biopsy ≤45 days. Of these, 50% were taken by protocol and 50% because of clinical reasons. In 164 cases (74%), rejection changes had resolved. At 1-year, median creatinine was 1.3 mg/dL in those without rejection, 1.6 mg/dL in patients with persistent changes, and 1.5 mg/dL in those with resolved changes. Persistent histologic rejection within 45 days was associated with inferior long-term graft survival.

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