The edition · Nephrology
Early T cell-mediated rejection is not benign: persistent inflammation linked to triple the graft loss
A six-centre cohort of 5,762 kidney transplant recipients found that a third of early rejections persisted despite treatment, and that clinical response often did not match the biopsy.
The edition in brief
Across six US and European centres, 790 of 5,762 kidney transplant recipients (13.6%) had T cell-mediated rejection in the first year. After treatment, 32% still had rejection on follow-up biopsy and 36% deteriorated clinically, and clinical and histological responses often disagreed. Rejection was associated with nearly three times the risk of death-censored graft loss (HR 2.84), and persistent rejection with three times the risk of responsive rejection (HR 3.21, 2.19–4.71). A Kidney International commentary on the LIPS trial notes that lanreotide did not slow measured GFR decline in ADPKD, supporting the KDIGO position against somatostatin analogues solely to preserve kidney function. A meta-analysis of four retrospective studies in 333 patients with a tumour in a solitary kidney found no difference in 12-month kidney function between robotic and open partial nephrectomy, with shorter stays on the robotic side. A meta-analysis of 66 machine learning models for diabetic kidney disease found high pooled AUC (0.93) but little external validation. The pearl covers reading creatinine after treating rejection.
Lanreotide did not slow measured GFR decline in ADPKD
Do not use somatostatin analogues to preserve kidney function in ADPKD; the last randomised trial showed no effect on measured GFR.
Robotic and open partial nephrectomy preserved function similarly in a solitary kidney
For a tumour in a solitary kidney, choose an experienced team over a particular approach, and follow kidney function closely.
Machine learning models for diabetic kidney disease look accurate but are rarely validated
Keep screening for diabetic kidney disease with albuminuria and eGFR; machine learning models are not yet validated for practice.
Creatinine is a late and imperfect marker of rejection response
Confirm rejection response with histology where possible, not creatinine alone.
Persistent early rejection linked to triple the risk of kidney graft loss
After treating early T cell-mediated rejection, consider a follow-up biopsy, because clinical response often misses persistent inflammation.
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