Histopathologic clusters differentiate subgroups within the nonspecific diagnoses of CAN or CR: Preliminary data from the DeKAF study

A. J. Matas, R. Leduc, D. Rush, J. M. Cecka, J. Connett, A. Fieberg, P. Halloran, L. Hunsicker, F. Cosio, J. Grande, R. Mannon, S. Gourishankar, R. Gaston, B. Kasiske

Research output: Contribution to journalArticle

59 Scopus citations

Abstract

The nonspecific diagnoses 'chronic rejection' 'CAN', or 'IF/TA' suggest neither identifiable pathophysiologic mechanisms nor possible treatments. As a first step to developing a more useful taxonomy for causes of new-onset late kidney allograft dysfunction, we used cluster analysis of individual Banff score components to define subgroups. In this multicenter study, eligibility included being transplanted prior to October 1, 2005, having a 'baseline' serum creatinine ≤2.0 mg/dL before January 1, 2006, and subsequently developing deterioration of graft function leading to a biopsy. Mean time from transplant to biopsy was 7.5 ± 6.1 years. Of the 265 biopsies (all with blinded central pathology interpretation), 240 grouped into six large (n > 13) clusters. There were no major differences between clusters in recipient demographics. The actuarial postbiopsy graft survival varied by cluster (p = 0.002). CAN and CNI toxicity were common diagnoses in each cluster (and did not differentiate clusters). Similarly, C4d and presence of donor specific antibody were frequently observed across clusters. We conclude that for recipients with new-onset late graft dysfunction, cluster analysis of Banff scores distinguishes meaningful subgroups with differing outcomes.

Original languageEnglish (US)
Pages (from-to)315-323
Number of pages9
JournalAmerican Journal of Transplantation
Volume10
Issue number2
DOIs
StatePublished - Feb 1 2010

Keywords

  • Allograft function
  • Kidney transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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    Matas, A. J., Leduc, R., Rush, D., Cecka, J. M., Connett, J., Fieberg, A., Halloran, P., Hunsicker, L., Cosio, F., Grande, J., Mannon, R., Gourishankar, S., Gaston, R., & Kasiske, B. (2010). Histopathologic clusters differentiate subgroups within the nonspecific diagnoses of CAN or CR: Preliminary data from the DeKAF study. American Journal of Transplantation, 10(2), 315-323. https://doi.org/10.1111/j.1600-6143.2009.02943.x