%0 Journal Article
%T Ahmedabad tolerance induction protocol and chronic renal allograft dysfunction: pathologic observations and clinical implications
%A Rashmi D Patel
%A Aruna V Vanikar
%A Feroz A Aziz
%A Pankaj R Shah
%A Hargovind L Trivedi
%J Diagnostic Pathology
%D 2009
%I BioMed Central
%R 10.1186/1746-1596-4-4
%X Biopsies diagnosed as per modified Banff criteria belonged to 2 groups: ATIP under low dose immunosuppression of cyclosporine/Azathioprine/Mycofenolate mofetil+ Prednisolone, subjected to donor leucocyte transfusion, anti-T/B cell antibodies, low dose target specific irradiation, cyclophosphamide, cyclosporin followed by HSCT pre-transplant; controls who opted out of ATIP were transplanted under standard triple drug immunosuppression. Demographics of both groups were comparable.Incidence of chronic changes was higher in controls (17.5%) vs. 10.98% in ATIP over a mean follow up of 151.9 months in the former and 130.9 months in the latter. Proteinuria and hypertension were higher in controls (48.4%) vs. ATIP (32.7%) with chronic transplant glomerulopathy, focal global sclerosis in 67.7% in controls vs. 46.7% in ATIP, acute on chronic T/B cell rejection in 51.6% controls vs. 28.1% ATIP, with peritubular capillary C4d deposits in 19.4% controls vs. 1.9% ATIP biopsies. Acute on chronic calcineurin inhibitor toxicity was higher in ATIP (71.9%) vs. 48.4% in controls.Chronic immune injury was less with ATIP vs controls as compared to a higher incidence of chronic calcineurin inhibitor toxicity in the former.Significant improvement in 1 year renal allograft and patient survival rates have been achieved over the last 10 years as a result of newer immunosuppressive regimes and the increasing use of living donors for transplantation. However long term graft function and survival rates remain less than optimal. Up to 50% grafts are lost to chronic renal allograft dysfunction (CRAD). [1] We have been modifying Ahmedabad Tolerance Induction Protocol (ATIP) to achieve transplantation tolerance in our renal allograft recipients since 1998. [2] We have effectively abrogated acute T-cell mediated rejections however we have not been able to address B-cell mediated rejections and CRAD. The present study aims to evaluate the effect of ATIP on CRAD in our living-related renal allograft re
%U http://www.diagnosticpathology.org/content/4/1/4