Korean J Transplant.  2022 Nov;36(Supple 1):S314. 10.4285/ATW2022.F-4537.

The outcome and risk factor of refractory T-cell–mediated rejection on renal allograft transplantation based on the Korean Organ Transplantation Registry

• Kwon EJ
• Yun GA
• Park S
• Kim S
• Chin HJ
• Na KY
• Chae DW
• Park HS
• Lee T
• Jeong JC

• KMID: 2535541
• DOI: http://doi.org/10.4285/ATW2022.F-4537

Abstract

Background
Refractory T-cell–mediated rejection (rTCMR) is a rare but critical complication affecting allograft survival in kidney transplantation (KT). We analyzed the outcome and risk factors of rTCMR in nationwide prospective KT cohort study.
Methods
Patients enrolled in the Korean Organ Transplantation Registry (KOTRY) who underwent KT from 2014 to 2021 were used for analysis. Logistic regression and cox regression were used. Primary outcome was death censored graft failure. Analysis of rejection was limited on events within 1 year of transplantation. The rTCMR was defined as a case in which creatinine was greater than 2.8 mg/dL even after treatment of TCMR or histologically persistent TCMR in the consecutive biopsy.
Results
A total of 9,150 donor-recipient pairs were analyzed. A 16% (n=1,472) incidence of a rejection detected including clinical or biopsy proven rejection. Among them, rTCMR occurred in 7.1% (n=105). Baseline characteristics were compared in three groups, no rejection after transplantation, rejection group except rTCMR, and rTCMR group. Recipients mean age (50.0 vs. 49.1vs. 48.8, P<0.023), male (59% vs. 65% vs. 73%, P<0.001), deceased donors (32% vs. 36% vs. 42%, P<0.002) and mean donor age (47.6 vs. 50.3 vs. 50.6, P<0.001) in three groups were identified. Age (odds ratio [OR], 0.976; 95% confidence interval [CI], 0.956– 0.996), cancer (OR, 2.398; 95% CI, 1.245–4.619) of recipient, deceased donor (OR, 2.704; 95% CI, 1.446–5.053), human leukocyte antigen (HLA) mismatch number (OR, 1.284; 95% CI, 1.119–1.472) were associated with refractory TCMR in multivariable logistic regression analysis. In no-rejection, resolved rejection, and rTCMR groups, death-censored graft survival rates at 1, 2, and 5 years were 99.1%, 98.5%, 97.1%, and 94.7%, 93.1%, 90.2%, and 61.2%, 58.7%, 48.9%, respectively.
Conclusions
The rTCMR is fatal risk factor to allograft survival. Age, malignancy history, HLA mismatch numbers, deceased donor kidney transplantation were independent risk factors.