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Background: Acute rejection occurs at any time following renal transplantation. The study aims to find the incidence, risk factors, and outcome of acute rejection in kidney transplantation. Materials and Methods: Retrospective cohort study conducted from January 2015 to April 2023, included patients with biopsy-proven acute graft rejection. Data were collected from electronic medical records. Rejection and no rejection groups were compared for the variables. Results: Out of 371 patients, acute rejection occurred in 36 (9.7%) patients at 1 year of transplantation. Thirty (8%) were early acute rejections (EARs) and 22 (6%) were late acute rejections (LARs). Higher human leukocyte antigen (HLA) mismatches, historical positive crossmatch, and history of blood transfusions were risk factors for acute rejection (P < 0.05). Incidence of LAR beyond 1 year was 11/23 (48%) in those who had received induction therapy at transplantation versus 5/29 (17.2%) in those who did not (P = 0.045). One out of five patients (3.4%) who received antithymocyte globulin (ATG) experienced EAR, in contrast to 8/18 (5.2%) patients who received basiliximab (P = 0.037). A complete response to treatment was observed in 22/30 (73.3%) patients with EAR and 2/22 (9.09%) with LAR (P < 0.001). At 23.77 ± 24.6 months of follow-up, graft survival was 12/12 (100%) in those with early T-cell-mediated rejection (TCMR) compared to 5/9 (55.6%) with late acute TCMR (P = 0.01). Conclusion: The incidence of acute rejection was highest within the first posttransplant year. Higher HLA mismatches, historical positive crossmatch, and history of blood transfusion were risk factors for acute rejection. ATG was effective in preventing EAR. LAR occurring beyond the first posttransplant year was independent of induction therapy at time of transplantation. Treatment response was better with EAR compared to LAR. Graft survival was better with early acute TCMR compared to late acute TCMR. [ABSTRACT FROM AUTHOR]

Background: Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking. Aim: To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series. Patients and Methods: Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early ( 12) months] and were assessed for sixteen histological parameters. Results: Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001). Conclusions: Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration.

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.

Object: Rejections observed in live donor liver transplants (LDLT) after the 6th month are defined as "late acute rejection" (LAR). Liver biopsy is still the gold standard for diagnosis of these cases. However, considering the morbidity and complications caused by this biopsy, can the non-invasive elevated serum eosinophil count be used as a predictive biomarker for LAR? Materials and Methods: Our research included patients with LDLT performed from June 2000 to June 2017 at Dokuz Eylül University Faculty of Medicine General Surgery Liver Transplant Unit, aged over 18 years and surviving at least 6 months. Patients developing late acute rejection were investigated in terms of demographic data, necessary graft weight/graft weight present ratio, cold ischemia duration, Child and MELD scores, doses of immunosuppressive agents before rejection, serum therapeutic levels and comorbidities. Our study retrospectively screened blood laboratory samples before biopsy and pathologic results of liver biopsies performed on patients with suspected LAR. Elevated serum eosinophil values were investigated and their effective role in diagnosis of LAR was researched. Results: Of 240 liver transplant cases included in the study, 65 (26.9%) had liver biopsy performed due to consideration of rejection linked to elevated liver function tests during follow-up. Of the biopsy transplant cases, 28 (43%) had LAR identified, while 37 (57%) had no finding of rejection encountered. The distribution of rejection in cases with rejection diagnosis was 10 (35.7%) mild, 13 (46.4%) moderate and 5 (17.9%) severe according to Banff pathology scoring. Of patients 21 (75%) were male and 7 (25%) were female. The mean follow-up duration was 3056 days (184-4877). The mean time of liver biopsy was the postoperative 660th day (180- 4354). There was a statistically significant correlation identified between elevated eosinophil count found in blood laboratory values before biopsy with LAR (p<0.001). Discussion and Conclusion: For diagnosis of LAR which may occur during follow-up of LDLT, the non-invasive method compared to liver biopsy of elevated serum eosinophil values may be used as a predictive marker. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Liver biopsy plays a crucial role in evaluating allograft dysfunction. Comprehensive analysis of the histological spectrum of complications, particularly rejection, in different time zones is lacking., Aim: To evaluate the histological spectrum of rejection, in four time zones, in a large Living donor liver transplant series., Patients and Methods: Retrospective analysis of 313 biopsies for the last 10 years of living donor liver transplantation (LDLT) recipients. 123 of which had rejection as diagnosis, were redistributed in four time zones [1-early (<3), 2-intermediate (3-6), 3 and 4-late (6-12 and > 12) months] and were assessed for sixteen histological parameters., Results: Biopsies in time zone 1 (26.5%), 2 (20.7%), 3 (24.6%), and 4 (28.1%)] were nearly equal. Multiple coexistent complications existed in 12% of the cases. Rejection diagnosed in time zone groups: 1 = 22 (17.9%), 2 = 27 (22%), 3 = 36 (29.3%), and 4 = 38 (30.9%). Portal inflammation mixed type (P < 0.000), portal vein (P = 0.001) and hepatic vein endothelialitis (P < 0.000), portal eosinophils (P = 0.001), and lymphocytic bile duct damage (P = 0.01) were most pronounced in group 1. Perivenulitis without hepatic vein endothelialitis was observed (P = 0.03) in groups 3, whereas bile duct atypia (P = 0.01) and duct loss (P < 0.000) were observed in group 4. Multiple episodes of rejection displayed significant association with central perivenulitis (P = 0.002) and bile duct loss (P < 0.001)., Conclusions: Histological analysis in large series of LDLT recipients highlights the spectrum of complications in different time zones. Late acute and chronic rejection occurred as early as 3 months posttransplant. Central perivenulitis and bile duct atrophy were associated with repeated episodes of rejection and deterioration., Competing Interests: None

This study was performed to investigate the clinical and pathologic features of C4d-positive steroid-resistant acute rejection (AR) at different phases after renal transplantation. Fifty-six kidney allograft recipients with C4d-positive AR were divided into three groups, very early rejection (VER, occurring 14 days following transplantation, n=28), early rejection (ER, occurring 15–180 days following transplantation, n=5), and late rejection (LR, occurring >180 days following transplantation, n=23). Clinical and pathological features were evaluated. Significantly more patients in the ER and LR groups were associated with a reduction or withdrawal of immunosuppressants. More patients in the ER and LR groups experienced a significant (>3 g/l) decrease in serum albumin (80% ER, 91.3% LR, 7.1% VER, P<0.001) and a decrease in hemoglobin (>1 g/dl) (80, 100 vs 17.9%, P<0.001). Most VER patients reported a fever and had very rapid graft dysfunction requiring dialysis. Significantly more patients (87%) had interstitial fibrosis and tubular atrophy in the LR group compared with the other groups and 13% had transplant glomerulopathy. Most cases of VER were reversed with tacrolimus and mycophenolate mofetil treatment, with or without immunoadsorption, with a 1-year survival rate of 96.4%, compared with only 60 and 52.2% in the ER and LR groups. In conclusion, C4d-positive steroid-resistant AR at different time points is associated with unique clinico-histopathological manifestations requiring distinct treatment strategies. Late episodes are usually associated with significantly reduced serum albumin and hemoglobin levels and a poorer outcome. A more specialized treatment protocol should be established for these patients.Kidney International (2006) 70, 377–383. doi:10.1038/sj.ki.5001552; published online 7 June 2006 [ABSTRACT FROM AUTHOR]