Chronic allograft injury by subclinical borderline change: evidence from serial protocol biopsies in kidney transplantation
민상일, 박영석, 안상현, 박태진, 박대도, 김서민, 문경철, 민승기, 김연수, 안규리, 김상준, 하종원,
소속 상세정보
민상일 ( Min Sang-Il )
Seoul National University College of Medicine Department of Surgery
박영석 ( Park Young-Suk )
Seoul National University College of Medicine Department of Surgery
안상현 ( Ahn Sang-Hyun )
Seoul National University College of Medicine Department of Surgery
박태진 ( Park Tae-Jin )
Seoul National University College of Medicine Department of Surgery
박대도 ( Park Dae-Do )
Seoul National University College of Medicine Department of Surgery
김서민 ( Kim Suh-Min )
Seoul National University College of Medicine Department of Surgery
문경철 ( Moon Kyung-Chul )
Seoul National University College of Medicine Department of Pathology
민승기 ( Min Seung-Kee )
Seoul National University College of Medicine Department of Surgery
김연수 ( Kim Yon-Su )
Seoul National University College of Medicine Department of Internal Medicine
안규리 ( Ahn Curie )
Seoul National University College of Medicine Department of Internal Medicine
김상준 ( Kim Sang-Joon )
Seoul National University College of Medicine Department of Surgery
하종원 ( Ha Jong-Won )
Seoul National University College of Medicine Department of Surgery
KMID : 0371320120830060343
Abstract
Purpose: This study investigated the impact of subclinical borderline changes on the development of chronic allograft injury in patients using a modern immunosuppression protocol. Methods: Seventy patients with stable renal allograft function and who underwent protocol biopsies at implantation, 10 days and 1 year after transplantation were included and classified based on biopsy findings at day 10. The no rejection (NR) group included 33 patients with no acute rejection. The treatment (Tx) group included 21 patients with borderline changes following steroid pulse therapy, and the nontreatment (NTx) group included 16 patients with borderline changes nontreated. Results: The Banff Chronicity Score (BChS) and modified BChS (MBChS) were not different among the three groups at implantation (P = 0.48) or on day 10 (P = 0.96). Surprisingly, the NTx group had more prominent chronic scores at the 1-year biopsy, including BChS (3.07 ± 1.33, P = 0.005) and MBChS (3.14 ± 1.41, P = 0.008) than those in the Tx and NR group, and deterioration of BChS was more noticeable in the NTx group (P = 0.037), although renal function was stable (P = 0.66). No difference in chronic injury scores was observed between the Tx and NR groups at the 1-year biopsy. Conclusion: Subclinical borderline changes can be a risk factor for chronic allograft injury and should be considered for antirejection therapy.
키워드
Borderline change; Chronic allograft injury; Kidney transplantation; Protocol kidney biopsy; Steroid pulse therapy
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