i-IFTA and chronic active T cell–mediated rejection: A tale of 2 (DeKAF) cohorts

Erika S Helgeson, Roslyn Mannon, Joseph Grande, Robert S. Gaston, Michael J. Cecka, Bertram L. Kasiske, David Rush, Sita Gourishankar, Fernando Cosio, Lawrence Hunsicker, John Connett, Arthur J. Matas

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Inflammation in areas of fibrosis (i-IFTA) in posttransplant biopsies is part of the diagnostic criteria for chronic active TCMR (CA TCMR -- i-IFTA ≥ 2, ti ≥ 2, t ≥ 2). We evaluated i-IFTA and CA TCMR in the DeKAF indication biopsy cohorts: prospective (n = 585, mean time to biopsy = 1.7 years); cross-sectional (n = 458, mean time to biopsy = 7.8 years). Grouped by i-IFTA scores, the 3-year postbiopsy DC-GS is similar across cohorts. Although a previous acute rejection episode (AR) was more common in those with i-IFTA on biopsy, the majority of those with i-IFTA had not had previous AR. There was no association between type of previous AR (AMR, TCMR) and presence of i-IFTA. In both cohorts, i-IFTA was associated with markers of both cellular (increased Banff i, t, ti) and humoral (increased g, ptc, C4d, DSA) activity. Biopsies with i-IFTA = 1 and i-IFTA ≥ 2 with concurrent t ≥ 2 and ti ≥ 2 had similar DC-GS. These results suggest that (a) i-IFTA≥1 should be considered a threshold for diagnoses incorporating i-IFTA, ti, and t; (b) given that i-IFTA ≥ 2,t ≥ 2, ti ≥ 2 can occur in the absence of preceding TCMR and that the component histologic scores (i-IFTA,t,ti) each indicate an acute change (albeit i-IFTA on the nonspecific background of IFTA), the diagnostic category “CA TCMR” should be reconsidered.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
StateAccepted/In press - 2020

Bibliographical note

Funding Information:
We thank Astellas, Bristol‐Myers Squibb, Novartis, Pfizer, and Sanofi‐Aventis for unrestricted grants that supported this research. We thank Stephanie Taylor for editorial assistance and preparation of the manuscript.


  • classification systems: Banff classification
  • clinical research / practice
  • fibrosis
  • graft survival
  • interstitial fibrosis and tubular atrophy
  • kidney transplantation / nephrology

PubMed: MeSH publication types

  • Journal Article

Fingerprint Dive into the research topics of 'i-IFTA and chronic active T cell–mediated rejection: A tale of 2 (DeKAF) cohorts'. Together they form a unique fingerprint.

Cite this