title: Inflammation in Early Kidney Allograft Surveillance Biopsies With and Without Associated Tubulointerstitial Chronic Damage as a Predictor of Fibrosis Progression and Development of De Novo Donor Specific Antibodies.
abstract: Interstitial fibrosis and tubular atrophy (IFTA) associated with interstitial inflammation in nonscarred areas (IFTA+i) is associated with poorer graft outcome than inflammation without IFTA or IFTA without inflammation.
  
  
  
  We evaluated if histological categories at week 6 could predict the development of interstitial fibrosis and de novo donor specific anti-HLA antibodies (dnDSA) at 1 year. Biopsies were classified according to Banff criteria as normal (i+t≤1 and ci+ct≤1), inflammation (i+t≥2 and ci+ct≤1), IFTA (i+t≤1 and ci+ct≥2) or IFTA+i (i+t≥2 and ci+ct≥2).
  
  
  
  We analyzed 598 standard immunological risk recipients. The histological diagnosis at 6 weeks was: normal (n = 206), inflammation (n = 29), IFTA (n = 255), and IFTA+i (n = 108). Moderate/severe interstitial fibrosis (ci≥2) at 1 year was observed in 4.2% of patients with prior (6 weeks) normal histology, in 3.4% with inflammation, in 13.8% with IFTA, and in 24.5% with IFTA+i (P = 0.0001). Fifty-three recipients (8.9%) had dnDSA at 1 year. Independent predictors of development of dnDSA at 1 year were: HLA-DR mismatches (odds ratio [OR], 1.95; 95% confidence interval [95% CI], 1.09-3.49), the presence of inflammation (OR, 5.49; 95% CI, 1.67-18.03) or IFTA+i (OR, 4.09; 95% CI, 1.67-10.0) in the 6-week surveillance biopsy.
  
  
  
  Early subclinical inflammation in surveillance biopsies with or without tubulointerstitial chronic lesions is associated with an increased risk of dnDSA development.
authors.affiliation: 1 Nephrology Department, Hospital Universitari Vall d'Hebron and Universitat Autonóma de Barcelona, Barcelona, Spain. 2 Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 3 Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway. 4 Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Clara
authors.initials: C
authors.lastname: García-Carro
authors.forename: Christina
authors.initials: C
authors.lastname: Dörje
authors.forename: Anders
authors.initials: A
authors.lastname: Åsberg
authors.forename: Karsten
authors.initials: K
authors.lastname: Midtvedt
authors.forename: Helge
authors.initials: H
authors.lastname: Scott
authors.forename: Finn P
authors.initials: FP
authors.lastname: Reinholt
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
authors.forename: Daniel
authors.initials: D
authors.lastname: Seron
authors.forename: Anna V
authors.initials: AV
authors.lastname: Reisæter
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D058070:Asymptomatic Diseases; D001284:Atrophy; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D006084:Graft Rejection / Q000097:blood / Q000276:immunology / Q000473:pathology; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009395:Nephritis, Interstitial / Q000097:blood / Q000276:immunology* / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies