title: The clinical impact of chronic transplant glomerulopathy in cyclosporine era.
abstract: BACKGROUND
  The clinical impact of chronic transplant glomerulopathy (CTG) on the outcome of kidney allograft receiving calcineurin inhibitors (CNIs) remains uncertain. A retrospective study of renal transplant recipients at Ospedale Maggiore of Milan was undertaken to evaluate the clinical outcome of patients with CTG.
  
  
  METHODS
  Among 666 biopsies taken at least 6 months after transplantation (Tx) in 498 transplant patients treated with CNIs, 28 cases (5.6%) of chronic transplant glomerulopathy (CTG) were identified and their clinical features at Tx, at follow-up and graft survival were compared with those of 56 controls transplanted in the same period and with kidney functioning 12 months after Tx. Clinical characteristics at biopsy and at 1 year after Tx were similar in the two groups.
  
  
  RESULTS
  After diagnosis graft function deteriorated in 22 patients (78.5%), while it remained stable in 6. Graft loss developed in 92 % of patients with proteinuria >2.5 g/day and in 33 % of those with lower proteinuria (P<0.005). In cases with more severe CTG the rate of graft loss was higher, though not significantly. Graft survival at 10 years was 48% in patients with CTG and 88% in controls (P<0.0001).
  
  
  CONCLUSIONS
  The incidence and clinical course of CTG do not seem to be modified by CNI-based immunosuppression. The evolution is unpredictable but the severity of glomerulopathy and proteinuria at follow-up are associated with progression to graft failure. Patients with CTG have a graft survival significantly worse than that of the general population of transplanted patients.
authors.affiliation: Division of Nephrology Ospedale Maggiore IRCCS, Milan, Italy. croff1policlinico.mi.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Banfi
authors.forename: Margarita
authors.initials: M
authors.lastname: Villa
authors.forename: Donata
authors.initials: D
authors.lastname: Cresseri
authors.forename: Claudio
authors.initials: C
authors.lastname: Ponticelli
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000503:physiopathology; D005260:Female; D006084:Graft Rejection / Q000473:pathology; D006801:Humans; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011507:Proteinuria / Q000175:diagnosis; D012189:Retrospective Studies
chemical_list: D003404:Creatinine