Late acute rejection in renal allografts: Clinical, pathologic, and follow-up data from a single tertiary care center

Abstract

Introduction: Late acute rejection (LAR) is different from early acute rejection with respect to risk factors, management, and prognosis. The long-term graft survival has been shown to be adverse after LAR. Materials and Methods: This was a prospective study including 15 biopsies reported as LAR in 12 patients. The clinical details, transplant duration, risk factors, biopsy findings, antirejection treatment, and outcome are studied. Results: The risk factors for developing LAR in our study included delayed graft function, associated infections, and noncompliance. Majority were combined cellular and antibody mediated. Antibody-mediated rejection (ABMR) component was identified in 13 biopsies. Plasma cell-rich form was seen in four biopsies. Most of the patients had persistent graft dysfunction with five of them going into graft loss. Conclusion: It is important to identify LAR, especially late ABMRs. They are different from chronic rejections. The graft outcome was found to be poor.

Keywords

• Allograft biopsy
• C4d
• graft loss
• late acute rejection