Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies

Fernando G Cosio, Mireille El Ters, L. D. Cornell, Carrie Schinstock, Mark D Stegall

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - 2015

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Allografts
Histology
Kidney
Biopsy
Graft Survival
Glomerulonephritis
Transplants
Odds Ratio

Keywords

  • Clinical research/practice
  • Glomerular biology and disease
  • Graft survival
  • Kidney transplantation/nephrology
  • Pathology/histopathology
  • Protocol biopsy
  • Translational research/science

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

@article{c4b22b768ba34802b4dc769db1fd7a64,
title = "Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies",
abstract = "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.",
keywords = "Clinical research/practice, Glomerular biology and disease, Graft survival, Kidney transplantation/nephrology, Pathology/histopathology, Protocol biopsy, Translational research/science",
author = "Cosio, {Fernando G} and {El Ters}, Mireille and Cornell, {L. D.} and Carrie Schinstock and Stegall, {Mark D}",
year = "2015",
doi = "10.1111/ajt.13423",
language = "English (US)",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",

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T1 - Changing Kidney Allograft Histology Early Posttransplant

T2 - Prognostic Implications of 1-Year Protocol Biopsies

AU - Cosio, Fernando G

AU - El Ters, Mireille

AU - Cornell, L. D.

AU - Schinstock, Carrie

AU - Stegall, Mark D

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - Clinical research/practice

KW - Glomerular biology and disease

KW - Graft survival

KW - Kidney transplantation/nephrology

KW - Pathology/histopathology

KW - Protocol biopsy

KW - Translational research/science

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U2 - 10.1111/ajt.13423

DO - 10.1111/ajt.13423

M3 - Article

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JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

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