title: The histology of kidney transplant failure: a long-term follow-up study.
abstract: BACKGROUND
  The relative impact on renal allograft outcome of specific histological diagnoses versus nonspecific chronic histological damage remains unclear.
  
  
  METHODS
  All 1,197 renal allograft recipients who were transplanted at a single center between 1991 and 2001 were included. All posttransplant renal allograft indication biopsies performed in this cohort during follow-up (mean, 14.5±2.80 years after transplantation) were rescored according to the current histological criteria and associated with death-censored graft outcome.
  
  
  RESULTS
  In this cohort, 1,365 allograft indication biopsies were performed. Specific diagnoses were present in 69.4% of graft biopsies before graft loss, but 30.6% of grafts did not have specific diagnoses in the last biopsy before graft loss. Only 14.6% of the patients did never have any specific disease diagnosed before graft loss. Extensive interstitial fibrosis and tubular atrophy without a clear cause was identified as the single cause of graft loss in only 6.9% of the cases. Acute T-cell-mediated rejection and changes suggestive of acute antibody-mediated rejection, diagnosed after the first year posttransplant, associated independently with graft survival. Transplant glomerulopathy increased over time after transplantation and represented a major risk for graft loss, as well as de novo or recurrent glomerular pathologies and polyomavirus nephropathy. Chronic histological injury associated with graft outcome, independent of specific diagnoses.
  
  
  CONCLUSIONS
  Renal allograft loss is multifactorial. Chronic histological damage and specific diseases had additive and independent impact on graft outcome. Chronic damage should be taken into account in prognostication of renal allograft outcome and could be implemented in treatment algorithms for specific diseases of kidney allografts.
authors.affiliation: 1 Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium. 2 Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium. 3 Department of Abdominal Transplantation Surgery, University Hospitals Leuven, Leuven, Belgium. 4 Department of Pathology, University Hospitals Leuven, Leuven, Belgium. 5 Department of Imaging and Pathology, KU Leuven, Leuven, Belgium. 6 Address correspondence to: Maarten Naesens, M.D., Ph.D., Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Herestraat 49 3000 Leuven, Belgium.
authors.forename: Maarten
authors.initials: M
authors.lastname: Naesens
authors.forename: Dirk R J
authors.initials: DR
authors.lastname: Kuypers
authors.forename: Katrien
authors.initials: K
authors.lastname: De Vusser
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel
authors.forename: Kathleen
authors.initials: K
authors.lastname: Claes
authors.forename: Bert
authors.initials: B
authors.lastname: Bammens
authors.forename: Björn
authors.initials: B
authors.lastname: Meijers
authors.forename: Ben
authors.initials: B
authors.lastname: Sprangers
authors.forename: Jacques
authors.initials: J
authors.lastname: Pirenne
authors.forename: Diethard
authors.initials: D
authors.lastname: Monbaliu
authors.forename: Ina
authors.initials: I
authors.lastname: Jochmans
authors.forename: Evelyne
authors.initials: E
authors.lastname: Lerut
mesh_terms: D001706:Biopsy; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D012307:Risk Factors; D014184:Transplantation, Homologous