Early subclinical rejection as a risk factor for late chronic humoral rejection

Transplantation. 2012 Jan 15;93(1):41-6. doi: 10.1097/TP.0b013e31823bb647.


Background: Subclinical rejection and interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsies are associated with outcome. We study the relationship between histologic lesions in early protocol biopsies and histologic diagnoses in late biopsies for cause.

Materials and methods: Renal transplants with a protocol biopsy performed within the first 6 months posttransplant between 1988 and 2006 were reviewed. Biopsies were evaluated according to Banff criteria, and C4d staining was available in biopsies for cause.

Results: Of the 517 renal transplants with a protocol biopsy, 109 had a subsequent biopsy for cause which showed the following histological diagnoses: chronic humoral rejection (CHR) (n=44), IF/TA (n=42), recurrence of the primary disease (n=11), de novo glomerulonephritis (n=7), T-cell-mediated rejection (n=4), and polyoma virus nephropathy (n=1). The proportion of retransplants (15.9% vs. 2.3%, P=0.058) and the prevalence of subclinical rejection were higher in patients with CHR than in patients with IF/TA (52.3% vs. 28.6%, P=0.0253). Demographic donor and recipient characteristics and clinical data at the time of protocol biopsy were not different between groups. Logistic regression analysis showed that subclinical rejection (relative risk, 2.52; 95% confidence interval, 1.1-6.3; P=0.047) but not retransplantation (relative risk, 6.7; 95% confidence interval, 0.8-58.8; P=0.085) was associated with CHR.

Conclusion: Subclinical rejection in early protocol biopsies is associated with late appearance of CHR.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy
  • Female
  • Glomerulonephritis / epidemiology
  • Glomerulonephritis / pathology
  • Graft Rejection / epidemiology*
  • Graft Rejection / immunology*
  • Graft Rejection / prevention & control
  • Humans
  • Immunity, Humoral / immunology*
  • Immunosuppressive Agents / therapeutic use
  • Kidney / pathology
  • Kidney Diseases / epidemiology
  • Kidney Diseases / pathology
  • Kidney Diseases / virology
  • Kidney Transplantation / immunology*
  • Kidney Transplantation / pathology
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors


  • Immunosuppressive Agents