Kidney allograft inflammation and fibrosis, causes and consequences

M. Gago, L. D. Cornell, W. K. Kremers, M. D. Stegall, F. G. Cosio

Research output: Contribution to journalArticlepeer-review

48 Scopus citations


This study assessed the development of allograft interstitial fibrosis and inflammation (GIF+"i"), a histologic pattern associated with reduced graft survival. Included are 795 adults, recipients of kidney allografts from 2000 to 2006. GIF+"i" was diagnosed in surveillance and clinical biopsies that had no transplant glomerulopathy. With time, posttransplant increasing number of grafts showed GIF+"i" and these patients had reduced death-censored graft survival (HR = 4.33 (2.49-7.53), p < 0.0001). Development of GIF+"i" was related to prior acute cellular rejection (ACR), BK nephropathy (PVAN), increasing number of HLA mismatches, retransplantation and DGF. However, 46.4% of GIF+"i" cases had no history of ACR or PVAN. Anti-HLA antibodies at transplant did not relate to GIF+"i" and these patients had no increased frequency of new antibody formation posttransplant. Post-ACR biopsies showed that GIF+"i" developed more commonly after clinically and/or histologically more severe ACR. Graft inflammation persisted in 38.7 and 29.6% of grafts 2 and 12 months post-ACR. Twelve months post-ACR, 27.1% of biopsies developed moderate-severe GIF and 51.8% showed GIF and inflammation. Persistent inflammation and progressive GIF is often subclinical but may lead to graft failure. GIF+"i" can be initiated by multiple etiologies but it is often postinfectious or due to persistent cellular immune-mediated injury. This study analyzes "graft interstitial fibrosis associated with inflammation" after kidney transplantation, the factors that relate to its development, and its implications for graft survival.

Original languageEnglish (US)
Pages (from-to)1199-1207
Number of pages9
JournalAmerican Journal of Transplantation
Issue number5
StatePublished - May 2012


  • Acute rejection
  • anti-HLA antibodies
  • graft failure
  • immunosuppression
  • protocol biopsies

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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