Journal
AMERICAN JOURNAL OF TRANSPLANTATION
Volume 11, Issue 10, Pages 2153-2161Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1600-6143.2011.03695.x
Keywords
Protocol biopsy; renal function; renal transplantation; subclinical inflammation
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Funding
- Roche SAS, France
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The long-term impact of subclinical acute rejection (SCAR) on renal graft function remains poorly understood. Furthermore, the interpretation of borderline lesions is difficult and their incidence is variable. The aim of this study was to analyze the characteristics of subclinical inflammation (SCI) in protocol biopsies performed 1-year after renal transplantation. SCI was defined as the presence of borderline lesions or SCAR according to the Banff 2005 classification. The patients included were a subpopulation of the CONCEPT study in which patients were randomized 3 months after transplantation to receive either sirolimus (SRL) or cyclosporine A (CsA) in combination with mycophenolate mofetil. At 1 year, we observed SCI in 37 of the 121 patients observed with an evaluable biopsy. The incidence was more frequent in the SRL group (SRL 45.2% vs. CsA 15.3%). At 30 months, SCI was associated with a significantly lower level of estimated glomerular filtration rate (mean MDRD 50.8 [+/- 13.3] vs. 57.7 [+/- 16.3] mL/min/1.73 m(2), p = 0.035). In conclusion, SCI at 1-year posttransplantation is associated with worsening renal function and is more frequent in SRL-treated patients. Therefore, evaluation of SCI may be a valuable tool to allow the optimization of immunosuppressive regimens.
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