Impact of subclinical inflammation on the development of interstitial fibrosis and tubular atrophy in kidney transplant recipients

R. L. Heilman, Y. Devarapalli, H. A. Chakkera, K. L. Mekeel, A. A. Moss, D. C. Mulligan, M. J. Mazur, K. Hamawi, J. W. Williams, K. S. Reddy

Research output: Contribution to journalArticle

81 Scopus citations

Abstract

Our aim was to study the impact of subclinical inflammation on the development of interstitial fibrosis and tubular atrophy (IF/TA) on a 1-year protocol biopsy in patients on rapid steroid withdrawal (RSW). A total of 256 patients were classified based on protocol biopsy findings at months 1 or 4. Group 1 is 172 patients with no inflammation, group 2 is 50 patients with subclinical inflammation (SCI), group 3 is 19 patients with subclinical acute rejection (SAR) and group 4 is 15 patients with clinical acute rejection (CAR). On the 1-year biopsy, more patients in group 2 (SCI) (34%, p = 0.004) and group 3 (SAR) (53%, p = 0.0002), had an IF/TA score > 2 compared to group 1 (control) (15%). IF/TA was not increased in group 4 (CAR) (20%). The percent with IF/TA score > 2 and interstitial inflammation (Banff i score > 0) was higher in group 2 (16%, p = 0.004) and group 3 (37%, p < 0.0001) compared to group 1 (3%). In a multivariate analysis, patients in groups 2 or 3 had a higher risk of IF/TA score > 2 on the 1-year biopsy (OR 6.62, 95% CI 2.68-16.3). We conclude that SCI and SAR increase the risk of developing IF/TA in patient on RSW.

Original languageEnglish (US)
Pages (from-to)563-570
Number of pages8
JournalAmerican Journal of Transplantation
Volume10
Issue number3
DOIs
StatePublished - Mar 2010

Keywords

  • Acute rejection
  • Interstitial fibrosis and tubular atrophy
  • Kidney transplantation
  • Protocol kidney biopsy
  • Rapid steroid withdrawal

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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