84, 95% CI 0.73∼0.95). When clinical variables were combined with genes, the diagnostic accuracy increased 0.96 (95% CI 0.91∼1.00) in the five gene set and 0.94 (95% CI 0.89∼1.00) in the two gene set. Conclusion: These results support the validity of 5 gene-set for the prediction of AR in Asian adult kidney transplant recipients and suggest the promising role of the peripheral blood gene test in the diagnosis of AR in kidney transplantation. LIM LI HAN, NG KOK PENG, LIM SOO KUN, TAN LI PING, KENG TEE CHAU, CHONG YIP BOON, KONG WAI YEW Division of Nephrology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia Introduction: Several studies have consistently shown that subclinical
rejection (SCR) is associated with chronic tubulointerstitial damage, subsequent renal dysfunction and reduced graft survival. This study 17-AAG investigated whether serum neutrophil gelatinase–associated lipocalin (NGAL) can detect SCR found in protocol biopsies allowing for a less invasive screening procedure. Methods: In this pilot study from June of 2012 to December of 2013, a total of 66 protocol biopsies were taken from patients with serum
creatinine not exceeding 130 μmol/L. At the similar setting, serum NGAL was measured. We instituted protocol biopsies in routine practice at 1, 3, 6 and 12 months, and yearly. We defined SCR as acute rejection identified from a biopsy specimen without concurrent functional deterioration (a serum creatinine not exceeding 20% of baseline values). Results: Six
rigidly defined groups (“Normal histology” RG-7388 [n = 30], “Borderline SCR” [as Banff i1 and t1] [n = 15], “Acute SCR” [as Banff i2 and t2 or worse] [n = 2], “Antibody-mediated SCR” [n = 1], “Both SPTLC1 cellular and antibody-mediated SCR” [n = 3], and “Other histologic changes” [n = 15]) were compared for differences in serum NGAL, presented in Table 1. Compared with the “Normal histology” group, all except for “Acute SCR,” had a higher mean of serum NGAL (“Borderline SCR,” P < 0.001, “Both cellular and antibody-mediated SCR,” P = 0.307, “Other histologic changes,” P < 0.001). Conclusion: Serum NGAL could possibly allow for a clear differentiation between stable transplants with normal histology and stable transplants with important histologic changes apart from subclinical rejection. Therefore, serum NGAL could be an alternative tool to screen for subclinical rejection in situation which protocol biopsy is not possible. Large-scale, multicenter, prospective trials of serum NGAL are required to assess fully its place in the detection of subclinical rejection in stable transplant patients. WU KENNETH, S1, COXALL OWEN2 1Damai Specialist Hospital; 2University of Oxford, UK Introduction: Renal transplant immunosuppressive agents continue to generate much interest. Alemtuzumab(campath), a humanized anti CD 52 antibody has been reported by some centres as a promising agent apart from it being cost effective.