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Master Thesis

Rejet infraclinique en transplantation rénale : impact sur la survie à long terme des greffons

Abstract : Background: the aim of the study is to assess the consequences of subclinical rejection on long-term kidney allograft survival. Methods: we performed an observational prospective study including 1307 patients who underwent kidney transplantation in Paris (2005-2010). Clinically stable participants underwent prospective screening biopsies at one year post transplant, with concurrent evaluations of circulating anti-HLA antibodies. Results: the main analysis included 1001 patients. Three distinct groups of patients were identified at the 1-year screening: 727 (73%) patients without rejection, 132 (13%) patients with subclinical T cell-mediated rejection (sTCMR) and 142 (14%) patients with subclinical antibody-mediated rejection (sABMR). Patients with sABMR had the poorest graft survival at 8 years post-transplant (56%) compared with subclinical TCMR (88%) and non-rejection (90%) groups (P<0.001). In a multivariate Cox model, subclinical ABMR at 1 year was independently associated with a 3.5-fold increase in allograft loss (95%CI: 2.1-5.7), independent of glomerular filtration rate and proteinuria (P<0.001). Conclusion: our findings suggest that sTCMR and sABMR have distinct effects on long-term kidney allograft survival. sABMR detected at the 1-year screening biopsy carries a prognostic value independent allograft function and proteinuria.
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Master Thesis
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Benjamin Laffy. Rejet infraclinique en transplantation rénale : impact sur la survie à long terme des greffons. Médecine humaine et pathologie. 2016. ⟨dumas-01647655⟩

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