title: Transplant glomerulopathy: clinical and pathological correlations.
abstract: OBJECTIVE
  Chronic transplant glomerulopathy (TG) is one of the leading causes of severe posttransplantation proteinuria and graft loss. Our current knowledge about risk factors for the development of TG, as well as factors that affect its dynamics and prognosis, is poor. We sought to describe the pathological and clinical risk factors and correlations of TG as well as parameters that influenced the survival of grafts with that pathology.
  
  
  METHODS
  We retrospectively reevaluated 86 kidney transplant cases with TG that have been recognized on the basis of an indication biopsy since 1997. All TG as well as all pre-TG (previous) biopsies were characterized for the presence of C4d deposits in the graft.
  
  
  RESULTS
  Younger recipient age and minimal immunosuppression due to drug withdrawal or suboptimal drug doses/blood levels within 3 to 6 months preceding the biopsy were associated with C4d deposition in peritubular capillaries (PTC; P = .0053 and P = .0365, respectively). Diffuse PTC-itis (P = .029, RR [95% confidence interval] = 3.349 [1.131-9.919]) and total interstitial inflammation score (P = .015, RR [95% confidence interval] = 9.662 [1.784-52.329]) were observed to show a negative impact on graft survival. C4d deposition in PTC and glomeruli, the level of pretransplantation sensitization, episodes of acute rejection, and C4d in previous (pre-TG) biopsies did not influence the survival of grafts with TG.
  
  
  CONCLUSIONS
  Younger recipient age and minimal immunosuppression were associated with C4d positivity in grafts with TG. The survival of kidney grafts with TG was significantly affected by the magnitude of inflammation in the interstitium and PTC, but not by C4d positivity in PTC and glomeruli.
authors.affiliation: Department of Transplantology and Nephrology, Warsaw Medical University, Warsaw, Poland. aggape@pczta.onet.pl
authors.forename: A
authors.initials: A
authors.lastname: Perkowska-Ptasińska
authors.forename: M
authors.initials: M
authors.lastname: Ciszek
authors.forename: A
authors.initials: A
authors.lastname: Chmura
authors.forename: Z
authors.initials: Z
authors.lastname: Galazka
authors.forename: L
authors.initials: L
authors.lastname: Paczek
authors.forename: M
authors.initials: M
authors.lastname: Durlik
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002196:Capillaries / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007249:Inflammation / Q000473:pathology; D007672:Kidney Cortex / Q000473:pathology; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation / Q000473:pathology* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology*; D011507:Proteinuria / Q000473:pathology; D012079:Renal Circulation; D012189:Retrospective Studies; D055815:Young Adult