title: Long-term kidney allograft survival in patients with transplant glomerulitis.
abstract: BACKGROUND
  Renal transplant glomerulitis (G) is associated with acute antibody-mediated rejection (ABMR) in the presence of donor-specific antibodies. However, the long-term prognosis of isolated G (isG) in the absence of donor-specific antibodies or G in combination with T cell-mediated rejection (TCMR) remains unexplored.
  
  
  METHODS
  Seventy recipients with G were included in this retrospective study and subdivided into 3 groups: isG, G with TCMR (G+TCMR), and G with acute ABMR. The control groups were: patients with TCMR Banff type I or II without G (TCMR) and patients without rejection (NR). Kaplan-Meier death-censored survival plots and Cox regression were used to analyze graft survival. The combined graft survival endpoint was defined as a return to dialysis or estimated glomerular filtration rate less than 15 mL/min/1.73 m. The median follow-up was 37 (14; 77) months from biopsy.
  
  
  RESULTS
  Graft survival was significantly lower in patients with G than in the NR and TCMR groups. No significant differences were observed among the isG, G+TCMR, and ABMR groups. Graft survival was lower in the G+TCMR group than in the TCMR group. Glomerulitis was independently associated with the risk of adverse graft outcome in a multivariate Cox regression model adjusted for other confounders (hazard ratio, 4.52 [95% confidence interval, 2.37-8.68] vs controls; P<0.001).
  
  
  CONCLUSIONS
  Glomerulitis is strongly associated with increased risk of graft failure. Graft survival in patients with isG that do not meet the Banff criteria for acute/active ABMR and in patients with G accompanying TCMR is comparable to the ABMR group.
authors.affiliation: 1 Department of Nephrology, Nephrology Center of Lower Saxony, Hann. Muenden, Germany. 2 Department of Nephrology, 1st St. Petersburg Pavlov State Medical University, St. Petersburg, Russian Federation. 3 Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany. 4 Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nabokow
authors.forename: Vladimir A
authors.initials: VA
authors.lastname: Dobronravov
authors.forename: Maria
authors.initials: M
authors.lastname: Khrabrova
authors.forename: Hermann-Josef
authors.initials: HJ
authors.lastname: Gröne
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Gröne
authors.forename: Michael
authors.initials: M
authors.lastname: Hallensleben
authors.forename: Daniela
authors.initials: D
authors.lastname: Kieneke
authors.forename: Peter
authors.initials: P
authors.lastname: Weithofer
authors.forename: Alexei V
authors.initials: AV
authors.lastname: Smirnov
authors.forename: Volker
authors.initials: V
authors.lastname: Kliem
mesh_terms: D000328:Adult; D064591:Allografts; D000906:Antibodies / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors
chemical_list: D000906:Antibodies