Long-Term Kidney Allograft Survival in Patients With Transplant Glomerulitis. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Nabokow, Alexander; Dobronravov, Vladimir A.; Khrabrova, Maria; Gröne, Hermann-Josef; Gröne, Elisabeth; Hallensleben, Michael; Kieneke, Daniela; Weithofer, Peter; Smirnov, Alexei V.; Kliem, Volker
• Is Part Of: Transplantation. Volume 99:Issue 2(2015)
• Publication Date: 2015-02
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000000606
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Renal transplant glomerulitis (G) is associated with acute antibody-mediated rejection (ABMR) in the presence of donor-specific antibodies. However, the long-term prognosis of isolated G (isG) in the absence of donor-specific antibodies or G in combination with T cell–mediated rejection (TCMR) remains unexplored. Methods: Seventy recipients with G were included in this retrospective study and subdivided into 3 groups: isG, G with TCMR (G + TCMR), and G with acute ABMR. The control groups were: patients with TCMR Banff type I or II without G (TCMR) and patients without rejection (NR). Kaplan-Meier death-censored survival plots and Cox regression were used to analyze graft survival. The combined graft survival endpoint was defined as a return to dialysis or estimated glomerular filtration rate less than 15 mL/min/1.73 m 2 . The median follow-up was 37 (14; 77) months from biopsy. Results: Graft survival was significantly lower in patients with G than in the NR and TCMR groups. No significant differences were observed among the isG, G + TCMR, and ABMR groups. Graft survival was lower in the G + TCMR group than in the TCMR group. Glomerulitis was independently associated with the risk of adverse graft outcome in a multivariate Cox regression model adjusted for other confounders (hazard ratio, 4.52 [95% confidence interval, 2.37-8.68] vs controls; P < 0.001). Conclusions: Glomerulitis is strongly associated with increased risk of graft failure. Graft survival in patients with isG that do not meet the Banff criteria for acute/active ABMR and in patients with G accompanying TCMR is comparable to the ABMR group. Abstract : Isolated glomerulitis lesions are associated with poorer graft outcomes, similar to glomerulitis in the context of T cell or antibody-mediated rejection. The results suggest isolated 'g' lesions have underlying cellular or humoral immunity with implications for management. Supplemental digital content is available in the text.