title: Early subclinical rejection as a risk factor for late chronic humoral rejection.
abstract: BACKGROUND
  Subclinical rejection and interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsies are associated with outcome. We study the relationship between histologic lesions in early protocol biopsies and histologic diagnoses in late biopsies for cause.
  
  
  METHODS
  Renal transplants with a protocol biopsy performed within the first 6 months posttransplant between 1988 and 2006 were reviewed. Biopsies were evaluated according to Banff criteria, and C4d staining was available in biopsies for cause.
  
  
  RESULTS
  Of the 517 renal transplants with a protocol biopsy, 109 had a subsequent biopsy for cause which showed the following histological diagnoses: chronic humoral rejection (CHR) (n=44), IF/TA (n=42), recurrence of the primary disease (n=11), de novo glomerulonephritis (n=7), T-cell-mediated rejection (n=4), and polyoma virus nephropathy (n=1). The proportion of retransplants (15.9% vs. 2.3%, P=0.058) and the prevalence of subclinical rejection were higher in patients with CHR than in patients with IF/TA (52.3% vs. 28.6%, P=0.0253). Demographic donor and recipient characteristics and clinical data at the time of protocol biopsy were not different between groups. Logistic regression analysis showed that subclinical rejection (relative risk, 2.52; 95% confidence interval, 1.1-6.3; P=0.047) but not retransplantation (relative risk, 6.7; 95% confidence interval, 0.8-58.8; P=0.085) was associated with CHR.
  
  
  CONCLUSIONS
  Subclinical rejection in early protocol biopsies is associated with late appearance of CHR.
authors.affiliation: Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Moreso
authors.forename: Marta
authors.initials: M
authors.lastname: Carrera
authors.forename: Montse
authors.initials: M
authors.lastname: Goma
authors.forename: Miguel
authors.initials: M
authors.lastname: Hueso
authors.forename: Joana
authors.initials: J
authors.lastname: Sellares
authors.forename: Jaume
authors.initials: J
authors.lastname: Martorell
authors.forename: Josep M
authors.initials: JM
authors.lastname: Grinyó
authors.forename: Daniel
authors.initials: D
authors.lastname: Serón
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D005921:Glomerulonephritis / Q000453:epidemiology / Q000473:pathology; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology* / Q000517:prevention & control; D006801:Humans; D056724:Immunity, Humoral / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents