Pure T-cell mediated rejection following kidney transplant according to response to treatment

Hyunwook Kwon; Young Hoon Kim; Youngmin Ko; Seong Jun Lim; Joo Hee Jung; Chung Hee Baek; Hyosang Kim; Su-Kil Park; Sung Shin; Yong-Pil Cho

doi:10.1371/journal.pone.0256898

Pure T-cell mediated rejection following kidney transplant according to response to treatment

PLoS One. 2021 Sep 3;16(9):e0256898. doi: 10.1371/journal.pone.0256898. eCollection 2021.

Authors

Affiliations

¹ Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
² Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
³ Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

The focus of studies on kidney transplantation (KT) has largely shifted from T-cell mediated rejection (TCMR) to antibody-mediated rejection (ABMR). However, there are still cases of pure acute TCMR in histological reports, even after a long time following transplant. We thus evaluated the impact of pure TCMR on graft survival (GS) according to treatment response. We also performed molecular diagnosis using a molecular microscope diagnostic system on a separate group of 23 patients. A total of 63 patients were divided into non-responders (N = 22) and responders (N = 44). Non-response to rejection treatment was significantly associated with the following factors: glomerular filtration rate (GFR) at biopsy, ΔGFR, TCMR within one year, t score, and IF/TA score. We also found that non-responder vs. responder (OR = 3.31; P = 0.036) and lower GFR at biopsy (OR = 0.56; P = 0.026) were independent risk factors of graft failure. The responders had a significantly superior overall GS rate compared with the non-responders (P = 0.004). Molecular assessment showed a good correlation with histologic diagnosis in ABMR, but not in TCMR. Solitary TCMR was a significant risk factor of graft failure in patients who did not respond to rejection treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Graft Rejection / immunology*
Humans
Kidney Transplantation* / adverse effects
Kidney Transplantation* / methods
Male
Middle Aged
Prognosis
Republic of Korea
Retrospective Studies
Risk Factors

Grants and funding

This study was supported by a grant (2018IF0803) from the Asan Institute for Life Sciences and Corporate Relations of Asan Medical Center, Seoul, Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.