Late kidney allograft rejection: the impact of pathology on the long-term outcome
Abstract
Rejection has always been one of the most important cause of late renal graft dysfunction. The aim of the study was to analyze the prevalence of different clinical and pathological variants of rejection that cause late graft dysfunction and to evaluate their impact on long-term outcome. A retrospective study included 294 needle core biopsy specimens from 265 renal transplant recipients with late (48,8 ± 46,1 months after transplantation) allograft dysfunction caused by late acute rejection (LAR n = 194) or chronic rejection (CR n = 78) or both (n = 22). C4d staining was performed by immunofluorescence (IF) on frozen sections using a standard protocol. Peritubular capillary C4d deposition was identified in 34% samples with acute rejection and in 59% cases of chronic rejection (65% cases of transplant glomerulopathy, and 50% of isolated chronic vasculopathy). 5-year graft survival for LAR vs CR vs combination were 48%, 34% и 17%, respectively. The outcome of C4d+ LAR was better (p < 0,01) than of C4d+ acute rejection: at 60 months, graft survival for diffuse C4d+ vs focal C4d+ vs C4d– were 29% vs 51% vs 43%, respectively. In cases of chronic rejection C4d+ vs C4d– was not statistically significant (34% vs 36%). By multivariate Cox analysis the risk of graft loss was associated with transplant glomerulopathy, intimal arteriitis, widespread interstitial fibrosis and plasma cell-rich infiltrates. Among clinical factors serum creatinine had a strongest impact on graft outcome: using Cox regression, the hazard ratio of graft loss was 1,6 (1,42–1,79) for each 0,1 mmol/l (p = 0,017). 5-year graft survival according to the initial serum creatinine were 97,5; 78,5; 67,8 and 20,7% for <0,2; 0,2–0,3; 0,3–0,4; >0,4 mmol/l respectively for LAR and 75; 33,9; 20,8 and 0% for CR. Proteinuria >3 g/d was a poor prognostic factor for LAR. No statistically significant difference was found for proteinuria vs mild to moderate urine protein level. In contrast for CR recipients only the absence of proteinuria had a significant positive impact on graft outcome compared with mild moderate or heavy proteinuria.
About the Authors
E. S. Stolyarevich
V.I. Shumakov Federal Scientific Center of Transplantology and artificial organs of Russian Health Ministry, Moscow; Department of Nephrology, Moscow Medical-dental University
Russian Federation
Russian Federation
L. Y. Artyuhina
Moscow City hospital No 52
Russian Federation
Russian Federation
I. G. Kim
V.I. Shumakov Federal Scientific Center of Transplantology and artificial organs of Russian Health Ministry, Moscow
Russian Federation
Russian Federation
L. G. Kurenkova
V.I. Shumakov Federal Scientific Center of Transplantology and artificial organs of Russian Health Ministry, Moscow
Russian Federation
Russian Federation
N. A. Tomilina
V.I. Shumakov Federal Scientific Center of Transplantology and artificial organs of Russian Health Ministry, Moscow; Department of Nephrology, Moscow Medical-dental University; Moscow City hospital No 52
Russian Federation
Russian Federation
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Review
For citations:
Stolyarevich E.S., Artyuhina L.Y., Kim I.G., Kurenkova L.G., Tomilina N.A. Late kidney allograft rejection: the impact of pathology on the long-term outcome. Nephrology and Dialysis. 2012;14(4):242-252. (In Russ.)
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