Fernández-Vivar C, Cano-Cervantes JH, Matías-Carmona M, Hernández-Hernández RC

Language: Spanish
References: 25
Page: 87-96
PDF size: 364.02 Kb.

ABSTRACT

Introduction: the biopsy is the gold standard for the diagnosis of acute rejection in kidney transplant patients. The prognosis on the allograft after an acute rejection depends on the type, gravity, and the promptness of the identification of the immunological event. The objective of treatment for an acute antibody mediated rejection is to remove the antibodies coming from B cells and plasmatic cells, remove donor-specific antibodies, and stop the complement system damage. There are strategies for monitoring the antirejection response to the treatment 1) biochemical markers; 2) histological response and 3) donor-specific antibodies titles by mean fluorescence intensity (MFI). Objective: to evaluate the response of anti-rejection treatment corroborated by post-treatment biopsy in renal transplant patients with acute antibody-mediated rejection at the CMN 20 de Noviembre. Material and methods: retrospective, descriptive and analytical cohort study in kidney transplant patients with acute antibody mediated rejection by the review of medical reports and database from January 2015 to April 2021, we select 39 patients and eliminate 2 patients because they didn't have complete records, 37 patients finally included, who received antirejection treatment and have 3 months post treatment allograft biopsy. We compared biochemical and histological parameters from the biopsy at the time of acute antibody mediated rejection diagnosis and after anti rejection treatment. Statistical analysis: we did descriptive analysis by frequency, mean, median, standard deviation. We use χ² test for the categorical variables, t test or Z test for the continuous variables and Mann-Whitney U tests for ordinal and qualitative variables. The association by rejection and biochemical parameters by Spearman and Pearson and contingency coefficient for categorical variables. The survival analysis by Kaplan-Meier curves and Log-Rank test. Results: we found histological improvement in total inflammation (i, t, g, ptc, v) (p < 0.0001), i+t (p = 0.027), g+ptc (p < 0.0001), glomerulitis (g) (p = 0.001), C4d+ (p = 0.007) by Banff 2019 (p ≤ 0.05) between 2 groups, but not in CADI score (p > 0.999), and also biochemical parameters improvement, but 54% (20 patients) remain with rejection in the control biopsy, from them 95% have subclinical rejection and required an additional treatment. The incidence of opportunistic infections after anti rejection treatment was 13.5% (5 patients) with a media of presentation of 2 ± 0.5 months. The median tacrolimus levels at the time of acute antibody mediated rejection was 5.7 ng/mL (IQR 25-75% 4.45-5.75 ng/mL) and cyclosporin median levels was 97.8 ng/mL (IQR 25-75% 64-108 ng/dL). Conclusions: it's important to do protocol monitoring biopsy after an anti rejection treatment for a timely treatment to reach an impact in the surveillance allograft and patient quality of life.

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