Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies

被引:57
作者
Cosio, F. G. [1 ,2 ]
El Ters, M. [3 ]
Cornell, L. D. [2 ,4 ]
Schinstock, C. A. [1 ,2 ]
Stegall, M. D. [2 ,5 ]
机构
[1] Mayo Clin, Dept Internal Med, Div Nephrol & Hypertens, Rochester, MN USA
[2] Mayo Clin, William von Liebig Ctr Transplant & Clin Regenera, Rochester, MN USA
[3] Univ Kansas, Div Nephrol & Hypertens, Lawrence, KS 66045 USA
[4] Mayo Clin, Dept Pathol, Rochester, MN USA
[5] Mayo Clin, Dept Surg, Rochester, MN USA
关键词
POLYOMAVIRUS-ASSOCIATED NEPHROPATHY; ANTIBODY-MEDIATED REJECTION; TRANSPLANT GLOMERULOPATHY; WORKING CLASSIFICATION; SUBCLINICAL REJECTION; DIAGNOSIS; TACROLIMUS; RISK; CYCLOSPORINE; INFLAMMATION;
D O I
10.1111/ajt.13423
中图分类号
R61 [外科手术学];
学科分类号
摘要
Allograft histology 1 year posttransplant is an independent correlate to long-term death-censored graft survival. We assessed prognostic implications of changes in histology first 2 years posttransplant in 938 first kidney recipients, transplanted 1999-2010, followed for 93.4 +/- 37.7 months. Compared to implantation biopsies, histology changed posttransplant showing at 1 year that 72.6% of grafts had minor abnormalities (favorable histology), 20.2% unfavorable histology, and 7.2% glomerulonephritis. Compared to favorable, graft survival was reduced in recipients with unfavorable histology (hazards ratio [HR] = 4.79 [3.277.00], p < 0.0001) or glomerulonephritis (HR = 5.91 [3.17-11.0], p < 0.0001). Compared to unfavorable, in grafts with favorable histology, failure was most commonly due to death (42% vs. 70%, p < 0.0001) and less commonly due to alloimmune causes (27% vs. 10%, p < 0.0001). In 80% of cases, favorable histology persisted at 2 years. However, de novo 2-year unfavorable histology (15.3%) or glomerulonephritis (4.7%) related to reduced survival. The proportion of favorable grafts increased during this period (odds ratio = 0.920 [0.871-0.972], p = 0.003, per year) related to fewer DGF, rejections, polyoma-associated nephropathy (PVAN), and better function. Graft survival also improved (HR = 0.718 [0.550-0.937], p = 0.015) related to better histology and function. Evolution of graft histologic early posttransplant relate to long-term survival. Avoiding risk factors associated with unfavorable histology relates to improved histology and graft survival.
引用
收藏
页码:194 / 203
页数:10
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