POS-699 BORDERLINE REJECTION AMONG KIDNEY TRANSPLANT RECIPIENTS: WHERE DOES THE TREATMENT STAND

Borderline rejection is a frequently encountered diagnosis in the post-transplant period. According to the Banff classification of renal allograft pathology, the category of borderline changes uses a lower diagnostic threshold that is insufficient to fulfill criteria for a diagnosis of acute T cell-mediated rejection. There is still controversy hovering around this diagnosis and speculating that it is more of a T cell acute rejection with incomplete criteria for the full diagnosis. The relationship between borderline changes and graft survival still remains unclear. Thus the therapeutic behavior differs from one department to another. Herein is a descriptive and analytic single-center study that was conducted in the department of clinical nephrology and transplantation at Fattouma Bourguiba university hospital in Monastir - Tunisia. 112 kidney transplant recipients were gathered between the years 2008 and 2018 .20 patients were identified to have a histological diagnosis of BORDERLINE changes on kidney biopsies that were performed in response to kidney allograft dysfunction. Mean age was 32 +/- 12 years (ranging from 20 to 46) for recipients and 39 +/- 16 years (range: 26-61) for donors. Males were predominant among recipients (60% vs. 40%) and females were predominant among donors (80% vs. 20%). The mean serum creatinine level after the immediate graft was 161 μmol / L (range 87-513 μmol. / L). These levels were achieved after a median of 20 days (interquartile range: 3-56). Biopsies exhibiting borderline infiltrates were performed at a median duration of 4.7 days (interquartile range: 2-18) and the mean serum creatinine at the time of the biopsy was 250 μmol / L (range: 163-883). The biopsies showed borderline cellular infiltrates (interstitial inflammation 1 [i1] and tubulitis [t1] lesions with no transmural arteritis (v = 0)). All recipients except one received anti-rejection treatment: either by increasing doses of corticosteroids to 0.5 mg / kg / day (n = 3) or by administering intra venous solumedrol boli during 3 days followed by full-dose corticosteroids( n = 17). 17 of the recipients responded well to treatment with a decline in serum creatinine toward the baseline, with a mean serum creatinine of 195.37 μmol / L (range: 116-448 μmol / L). Only one patient did not improve his graft function and 2 patients were still under evaluation. This response was obtained within a median duration of 26.6 days (range: 4-45 days) after the start of treatment. The borderline cellular infiltrates may impact the long-term outcomes in kidney transplant recipients exposing the patient to late rejections, nephron loss, and kidney failure. Accordingly, treatment is paramount, and intensification of immunosuppression may be required. Close monitoring after treatment is mandatory.

Abstract licence: CC BY-NC-ND

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.