Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies.
Allograft histology 1 year posttransplant is an independent correlate to long-term death-censored graft survival. We assessed prognostic implications of changes in histology first 2 years posttransplant in 938 first kidney recipients, transplanted 1999-2010, followed for 93.4 ± 37.7 months. Compared to implantation biopsies, histology changed posttransplant showing at 1 year that 72.6% of grafts had minor abnormalities (favorable histology), 20.2% unfavorable histology, and 7.2% glomerulonephritis. Compared to favorable, graft survival was reduced in recipients with unfavorable histology (hazards ratio [HR] = 4.79 [3.27-7.00], p < 0.0001) or glomerulonephritis (HR = 5.91 [3.17-11.0], p < 0.0001). Compared to unfavorable, in grafts with favorable histology, failure was most commonly due to death (42% vs. 70%, p < 0.0001) and less commonly due to alloimmune causes (27% vs. 10%, p < 0.0001). In 80% of cases, favorable histology persisted at 2 years. However, de novo 2-year unfavorable histology (15.3%) or glomerulonephritis (4.7%) related to reduced survival. The proportion of favorable grafts increased during this period (odds ratio = 0.920 [0.871-0.972], p = 0.003, per year) related to fewer DGF, rejections, polyoma-associated nephropathy (PVAN), and better function. Graft survival also improved (HR = 0.718 [0.550-0.937], p = 0.015) related to better histology and function. Evolution of graft histologic early posttransplant relate to long-term survival. Avoiding risk factors associated with unfavorable histology relates to improved histology and graft survival.
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.|William von Liebig Center for Transplant and Clinical Regeneration, Mayo Clinic, Rochester, MN.
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Cosio
Division of Nephrology and Hypertension, University of Kansas, Lawrence, KS.
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El Ters
William von Liebig Center for Transplant and Clinical Regeneration, Mayo Clinic, Rochester, MN.|Department of Pathology, Mayo Clinic, Rochester, MN.
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Cornell
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.|William von Liebig Center for Transplant and Clinical Regeneration, Mayo Clinic, Rochester, MN.
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Schinstock
William von Liebig Center for Transplant and Clinical Regeneration, Mayo Clinic, Rochester, MN.|Department of Surgery, Mayo Clinic, Rochester, MN.
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Stegall
D064591:Allografts / Q000473:pathology*; D001706:Biopsy; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D013997:Time Factors
Clinical research/practice; glomerular biology and disease; graft survival; kidney transplantation/nephrology; pathology/histopathology; protocol biopsy; translational research/science