title: Glomerular damage as a predictor of renal allograft loss.
abstract: Interstitial fibrosis and tubular atrophy (IF/TA) are the most common cause of renal graft failure. Chronic transplant glomerulopathy (CTG) is present in approximately 1.5-3.0% of all renal grafts. We retrospectively studied the contribution of CTG and recurrent post-transplant glomerulopathies (RGN) to graft loss. We analyzed 123 patients with chronic renal allograft dysfunction and divided them into three groups: CTG (N = 37), RGN (N = 21), and IF/TA (N = 65). Demographic data were analyzed and the variables related to graft function identified by statistical methods. CTG had a significantly lower allograft survival than IF/TA. In a multivariate analysis, protective factors for allograft outcomes were: use of angiotensin-converting enzyme inhibitor (ACEI; hazard ratio (HR) = 0.12, P = 0.001), mycophenolate mofetil (MMF; HR = 0.17, P = 0.026), hepatitis C virus (HR = 7.29, P = 0.003), delayed graft function (HR = 5.32, P = 0.016), serum creatinine > or =1.5 mg/dL at the 1st year post-transplant (HR = 0.20, P = 0.011), and proteinuria > or =0.5 g/24 h at the 1st year post-transplant (HR = 0.14, P = 0.004). The presence of glomerular damage is a risk factor for allograft loss (HR = 4.55, P = 0.015). The presence of some degree of chronic glomerular damage in addition to the diagnosis of IF/TA was the most important risk factor associated with allograft loss since it could indicate chronic active antibody-mediated rejection. ACEI and MMF were associated with better outcomes, indicating that they might improve graft survival.
authors.affiliation: Departamento de Medicina, Universidade Federal de São Paulo, SP, Brasil.
authors.forename: G
authors.initials: G
authors.lastname: Moscoso-Solorzano
authors.forename: N O S
authors.initials: NO
authors.lastname: Câmara
authors.forename: M F
authors.initials: MF
authors.lastname: Franco
authors.forename: S
authors.initials: S
authors.lastname: Araújo
authors.forename: F
authors.initials: F
authors.lastname: Ortega
authors.forename: A
authors.initials: A
authors.lastname: Pacheco-Silva
authors.forename: G
authors.initials: G
authors.lastname: Mastroianni-Kirsztajn
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D005355:Fibrosis; D006084:Graft Rejection / Q000473:pathology* / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007684:Kidney Tubules / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents