Isolated endarteritis and kidney transplant survival: a multicenter collaborative study.
Isolated endarteritis of kidney transplants is increasingly recognized. Notably, microarray studies revealed absence of immunologic signatures of rejection in most isolated endarteritis biopsy samples. We investigated if isolated endarteritis responds to rejection treatment and affects kidney transplant survival. We retrospectively enrolled recipients of kidney transplant who underwent biopsies between 1999 and 2011 at seven American and Canadian centers. Exclusion criteria were recipients were blood group-incompatible or crossmatch-positive or had C4d-positive biopsy samples. After biopsy confirmation, patients were divided into three groups: isolated endarteritis (n=103), positive controls (type I acute T cell-mediated rejection with endarteritis; n=101), and negative controls (no diagnostic rejection; n=103). Primary end points were improved kidney function after rejection treatment and transplant failure. Mean decrease in serum creatinine from biopsy to 1 month after rejection treatment was 132.6 µmol/L (95% confidence interval [95% CI], 78.7 to 186.5) in patients with isolated endarteritis, 96.4 µmol/L (95% CI, 48.6 to 143.2) in positive controls (P=0.32), and 18.6 µmol/L (95% CI, 1.8 to 35.4) in untreated negative controls (P<0.001). Functional improvement after rejection treatment occurred in 80% of patients with isolated endarteritis and 81% of positive controls (P=0.72). Over the median 3.2-year follow-up period, kidney transplant survival rates were 79% in patients with isolated endarteritis, 79% in positive controls, and 91% in negative controls (P=0.01). In multivariate analysis, isolated endarteritis was associated with an adjusted 3.51-fold (95% CI, 1.16 to 10.67; P=0.03) risk for transplant failure. These data indicate that isolated endarteritis is an independent risk factor for kidney transplant failure.
Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; bsis@ualberta.ca.
Banu
B
Sis
Department of Pathology and.
Serena M
SM
Bagnasco
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota;
Lynn D
LD
Cornell
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
Parmjeet
P
Randhawa
Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California;
Mark
M
Haas
Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada;
Belinda
B
Lategan
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and.
Alex B
AB
Magil
Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Andrew M
AM
Herzenberg
Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada;
Ian W
IW
Gibson
Department of Pathology and.
Michael
M
Kuperman
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
Kotaro
K
Sasaki
Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland;
Edward S
ES
Kraus
D000328:Adult; D001706:Biopsy; D004692:Endarteritis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
acute allograft rejection; kidney; transplantation; vasculitis