title: Morphologic patterns and treatment of transplant glomerulopathy: A retrospective analysis.
abstract: Transplant glomerulopathy is mainly due to chronic antibody-mediated rejection and actually represents a major cause of long-term allograft failure. The lack of effective treatment remains a serious problem in transplantation. A retrospective and uni-center study was performed in 48 kidney allograft recipients with transplant glomerulopathy between January 2010 and December 2015. Median time for diagnosis was 7.1 (3.6-11.8) years post-transplant. Light microscopy showed severity of transplant glomerulopathy in the majority of patients (cg1=10.4%; cg2=20.8%; cg3=68.8%). Moderate microvascular inflammation was present in 56.3% (g+ptc≥2), and almost half of recipients (51.1%) were C4d positive in immunofluorescence. Female gender (P=.001), age (P=.043), renal dysfunction (P=.002), acute rejection episodes (P=.026), and anti-HLA class II antibodies (P=.004) were associated with kidney allograft failure. Treatment of transplant glomerulopathy was performed in 67.6% of patients. The histologic and laboratory features that led to a therapeutic intervention were score ptc (P=.021), C4d (P=.03), and the presence of anti-HLA antibodies (P=.029), whereas score ah (P=.005) was associated with conservative measure. The overall cumulative kidney allograft survival at 10 years was 75%. Treatment of transplant glomerulopathy was ineffective to improve long-term kidney allograft survival.
authors.affiliation: Nephrology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal.
authors.forename: Rui
authors.identifier: 0000-0001-5974-4299
authors.initials: R
authors.lastname: Abreu
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Carvalho
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Viana
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Mesquita
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Marília
authors.initials: M
authors.lastname: Possante
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Aires
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Caeiro
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Cecília
authors.initials: C
authors.lastname: Silva
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Cotovio
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Aníbal
authors.initials: A
authors.lastname: Ferreira
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Remédio
authors.affiliation: Nephrology Department, Hospital Curry Cabral, Lisboa, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Nolasco
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D007678:Kidney Glomerulus / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D007518:Isoantibodies
keywords: chronic allograft rejection; histopathology; immunosupression; transplant glomerulopathy; treatment