Significance of revised criteria for chronic active T cell–mediated rejection in the 2017 Banff classification: Surveillance by 1‐year protocol biopsies for kidney transplantation. Issue 1 (13th July 2020)

• Record Type: Journal Article
• Authors: Nakagawa, Kaneyasu; Tsuchimoto, Akihiro; Ueki, Kenji; Matsukuma, Yuta; Okabe, Yasuhiro; Masutani, Kosuke; Unagami, Kohei; Kakuta, Yoichi; Okumi, Masayoshi; Nakamura, Masafumi; Nakano, Toshiaki; Tanabe, Kazunari; Kitazono, Takanari
• Is Part Of: American journal of transplantation. Volume 21:Issue 1(2021)
• Page Start: 174
• Page End: 185
• Publication Date: 2020-07-13
• Subjects: clinical research/practice -- kidney transplantation/nephrology -- kidney transplantation: living donor -- pathology/histopathology -- rejection: T cell mediated (TCMR); Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16093
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Diagnostic criteria for chronic active T cell–mediated rejection (CA‐TCMR) were revised in the Banff 2017 consensus, but it is unknown whether the new criteria predict graft prognosis of kidney transplantation. We enrolled 406 kidney allograft recipients who underwent a 1‐year protocol biopsy (PB) and investigated the diagnostic significance of Banff 2017. Interobserver reproducibility of the 3 diagnosticians showed a substantial agreement rate of 0.68 in Fleiss's kappa coefficient. Thirty‐three patients (8%) were classified as CA‐TCMR according to Banff 2017, and 6 were previously diagnosed as normal, 12 as acute TCMR, 10 with borderline changes, and 5 as CA‐TCMR according to Banff 2015 criteria. Determinant factors of CA‐TCMR were cyclosporine use (vs tacrolimus), previous acute rejection, and BK polyomavirus‐associated nephropathy. In survival analysis, the new diagnosis of CA‐TCMR predicted a composite graft endpoint defined as doubling serum creatinine or death‐censored graft loss (log‐rank test, P < .001). In multivariate analysis, CA‐TCMR was associated with the second highest risk of the composite endpoint (hazard ratio: 5.42; 95% confidence interval, 2.02‐14.61; P < .001 vs normal) behind antibody‐mediated rejection. In conclusion, diagnosis of CA‐TCMR in Banff 2017 may facilitate detecting an unfavorable prognosis of kidney allograft recipients who undergo a 1‐year PB. Abstract : A multicenter retrospective study shows that assessment of 1‐year protocol kidney biopsies according to the 2017 Banff revised diagnosis of chronic active T cell–mediated rejection may prognosticate poor allograft outcomes.