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Early subclinical rejection treated with low dose i.v. steroids is not associated to graft survival impairment: 13-years’ experience at a single center

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Abstract

Subclinical rejection (SCR) has been variably associated with reduced graft survival, development and progression of interstitial fibrosis/tubular atrophy and chronic allograft nephropathy, but data are controversial concerning SCR treatment in terms of graft survival improvement. In this single-center retrospective study, we enrolled 174 adult kidney transplant recipients with a protocol biopsy performed at 30 days after transplantation to evaluate the incidence rate and risk factors for early SCR and its impact on 10-year graft survival. Five patients showed primary non function and were excluded. Among 159/169 (94.08 %) patients with stable graft function who underwent protocol biopsy, 17 (10.7 %) showed signs of SCR and were treated with low-dose intravenous (i.v.) steroids. Ten patients showed functional impairment, 8 (4.73 %) resulting as acute rejection. At multivariate analysis, donor age [odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.01–1.09], and delayed graft function (DGF) (OR 1.08, 95 % CI 1.03–1.12) were significantly associated with SCR. The 10-year graft survival rate in the SCR group was similar to that in the normal-findings group (76.5 vs. 74.9 % respectively; p = 0.61). At multivariate Cox regression, acute [hazard ratio (HR) 5.22, 95 % CI 1.70–16.01], but not sub-clinical, rejection was independently associated with long-term graft failure. In conclusion, early protocol biopsy is a useful and safe tool to detect early SCR which seems not to affect the long-term survival. We suggest that this could be, probably, linked to early SCR treatment with low dose i.v. steroids.

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Acknowledgements

The authors gratefully acknowledge Armentano Filomena and Greco Angela for their nursing assistance in this study and all our Nephrology staff for their clinical assistance in this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. “Kidney and Transplantation” Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy

    Paolo Gigliotti, Danilo Lofaro, Francesca Leone, Teresa Papalia, Massimino Senatore, Rosita Greco, Anna Perri, Donatella Vizza, Simona Lupinacci, Giuseppina Toteda, Antonella La Russa & Renzo Bonofiglio

  2. Department of Anatomic Pathology, Annunziata Hospital, Cosenza, Italy

    Roberto De Stefano & Francesco Romeo

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  1. Paolo Gigliotti
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  2. Danilo Lofaro
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  3. Francesca Leone
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  4. Teresa Papalia
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Correspondence to Renzo Bonofiglio.

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Gigliotti, P., Lofaro, D., Leone, F. et al. Early subclinical rejection treated with low dose i.v. steroids is not associated to graft survival impairment: 13-years’ experience at a single center. J Nephrol 29, 443–449 (2016). https://doi.org/10.1007/s40620-015-0206-0

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  • DOI: https://doi.org/10.1007/s40620-015-0206-0

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