Correlation of Pathologic Staging by Banff Criteria with Rejection Reversal and Graft Outcome in Acute Renal Allograft Rejection / 대한이식학회지

ABSTRACT

PURPOSE: Acute renal allograft rejection is known to be an important prognostic factor of long-term graft survival. The purpose of this study was to make a treatment discipline in acute renal allograft rejection by finding any relationship between Banff classification of acute rejection and response to treatment and long term graft survival. MATERIALS AND METHODS: Thirty-eight cases histopathologically diagnosed as acute rejection were included in this study. The grade of acute rejection was classified according to Banff criteria (1997). Response to treatment was classified into three groups; complete (>75% reduction in serum creatinine increment), partial (25-75% reduction), and no response (>25% reduction). RESULT: Mean age of the patients at the time of biopsy was 32.3 years and male to female ratio was 2513. The mean interval between renal transplantation and rejection episode was 4.9 months. Mild, moderate and severe rejection according to Banff classification was 15, 15 and 8 cases respectively. Antirejection therapy with steroid pulse was initiated in all cases, antilymphocyte globulins (ALG or OKT3) in 19 cases and tacrolimus rescue therapy in one. All patients except for two (93%) with mild or moderate rejection showed complete or partial response, whereas responsiveness was noted only in three cases (38%) with severe rejection (p>0.01). 66.7% of cases with mild rejection showed complete response to steroid pulse therapy; 40% with moderate rejection; 0% with severe rejection (p=0.01). Patients with severe rejection had much poorer long term graft survival than with mild or moderate rejection (p=0.01). CONCLUSION: These results suggest that Banff classification of renal allograft rejection could be used as an indicator of treatment responsiveness and graft prognosis. They also suggest that a more intensive anti-rejection therapy should be recommended in high grade rejections.