THERAPEUTIC STRATEGIES FOR KIDNEY TRANSPLANTATION

R. Heilman, Y. Davarapalli, H. Chakkera, K. Mekeel, A. Moss, J. Williams, K. Hamawi, M. Mazur, D. Mulligan, K. Reddy
, Mayo Clinic, Phoenix/UNITED STATES OF AMERICA

Body: The aim was to study the impact of subclinical acute rejection (SAR) on graft survival in recipients on rapid steroid withdrawal (RSW).

Methods: All patients (pts) transplanted with kidney only between 7/03 and 6/08 treated with RSW were included. All pts received induction with either r-antithymocyte globulin or basiliximab. Steroids were stopped after 4th post op day. Immunosuppression included tacrolimus and mycophenolate mofetil. Protocol biopsies were done at months 1, 4 and annually. SAR is defined as acute rejection on protocol biopsy and creatinine within 0.3 mg/dL of previous baseline. Clinical acute rejection (CAR) was Bx proven with increased creatinine. AMR required histologic changes and positive c4d.

Results: 463 pts treated with RSW were included. 46 pts had SAR (10%) and 36 had CAR (8%). Baseline characteristics are shown in the table. Both AR groups had worse HLA matching, but otherwise the groups are similar. The Banff '05 classification of the acute rejections is given in the table. SAR was more likely to be milder AR. The figure shows Kaplan-Meier survival analysis for death or graft failure as the outcome and survival is inferior for both SAR and CAR (log rank p=0.006). Conclusion: In non sensitized kidney tx recipients treated with RSW, both SAR and CAR are associated with an inferior graft survival. Baseline Characteristics and Characteristics of Acute Rejection (AR) (*p<0.05, ** p=0.02 for overall Banff classification by Chi square)

Disclosure: All authors have declared no conflicts of interest.