Subclinical rejection in tacrolimus-treated renal transplant recipients

Transplantation. 2002 Jun 27;73(12):1965-8. doi: 10.1097/00007890-200206270-00023.

Abstract

Background: Subclinical rejection, defined as histologic acute rejection in the absence of graft dysfunction, has been suggested as a cause of chronic allograft rejection. In cyclosporine-treated patients, the incidence of subclinical rejection 3 months after transplant is reported to be approximately 30%. The intent of our study was to determine the incidence of subclinical rejection in tacrolimus-treated renal allograft recipients.

Methods: We prospectively studied the incidence of subclinical rejection on surveillance biopsies performed 3 months after transplantation in 114 patients transplanted between September 1, 1998 and November 30, 2000. All patients received tacrolimus, mycophenolate mofetil, and prednisone, and 56% received antibody induction.

Results: Subclinical rejection was detected in 2.6% of patients (3/114, 95% confidence interval 0.5-7.5%). Borderline changes were detected in 11% (12/114). Subclinical rejections were treated with bolus methylprednisolone.

Conclusions: The incidence of subclinical rejection early after kidney transplantation is extremely low in tacrolimus-treated patients in whom early rejections are aggressively treated, suggesting that surveillance biopsies may not be necessary with this regimen.

MeSH terms

  • Adult
  • Aged
  • Female
  • Graft Rejection / epidemiology*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Prospective Studies
  • Tacrolimus / therapeutic use*

Substances

  • Immunosuppressive Agents
  • Tacrolimus