Long-term follow-up of the DeKAF cross-sectional cohort study

Arthur J. Matas, Ann Fieberg, Roslyn B. Mannon, Robert Leduc, Joseph Peter Grande, Bertram L. Kasiske, Michael Cecka, Robert Gaston, Lawrence Hunsicker, John Connett, Fernando G Cosio, Sita Gourishankar, David Rush

Research output: Contribution to journalArticle

Abstract

The DeKAF study was developed to better understand the causes of late allograft loss. Preliminary findings from the DeKAF cross-sectional cohort (with follow-up < 20 months) have been published. Herein, we present long-term outcomes in those recipients (mean follow-up ± SD, 6.6 ± 0.7 years). Eligibility included being transplanted prior to October 1, 2005; serum creatinine ≤ 2.0 mg/dL on January 1, 2006; and subsequently developing new-onset graft dysfunction leading to a biopsy. Mean time from transplant to biopsy was 7.5 ± 6.1 years. Histologic findings and DSA were studied in relation to postbiopsy outcomes. Long-term follow-up confirms and expands the preliminary results of each of 3 studies: (1) increasing inflammation in area of atrophy (irrespective of inflammation in nonscarred areas [Banff i]) was associated with increasingly worse postbiopsy death-censored graft survival; (2) hierarchical analysis based on Banff scores defined clusters (entities) that differed in long-term death-censored graft survival; and (3) C4d−/DSA− recipients had significantly better (and C4d+/DSA+ worse) death-censored graft survival than other groups. C4d+/DSA- and C4d−/DSA+ had similar intermediate death-censored graft survival. Clinical and histologic findings at the time of new-onset graft dysfunction define high- vs low-risk groups for long-term death-censored graft survival, even years posttransplant. These findings can help differentiate groups for potential intervention studies.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2019

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Graft Survival
Cohort Studies
Cross-Sectional Studies
Transplants
Inflammation
Biopsy
Atrophy
Allografts
Creatinine
Serum

Keywords

  • antibody biology
  • chronic allograft nephropathy
  • classification systems: Banff classification
  • clinical research/practice
  • clinical trial
  • graft survival
  • kidney transplantation/nephrology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Matas, A. J., Fieberg, A., Mannon, R. B., Leduc, R., Grande, J. P., Kasiske, B. L., ... Rush, D. (Accepted/In press). Long-term follow-up of the DeKAF cross-sectional cohort study. American Journal of Transplantation. https://doi.org/10.1111/ajt.15204

Long-term follow-up of the DeKAF cross-sectional cohort study. / Matas, Arthur J.; Fieberg, Ann; Mannon, Roslyn B.; Leduc, Robert; Grande, Joseph Peter; Kasiske, Bertram L.; Cecka, Michael; Gaston, Robert; Hunsicker, Lawrence; Connett, John; Cosio, Fernando G; Gourishankar, Sita; Rush, David.

In: American Journal of Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Matas, AJ, Fieberg, A, Mannon, RB, Leduc, R, Grande, JP, Kasiske, BL, Cecka, M, Gaston, R, Hunsicker, L, Connett, J, Cosio, FG, Gourishankar, S & Rush, D 2019, 'Long-term follow-up of the DeKAF cross-sectional cohort study', American Journal of Transplantation. https://doi.org/10.1111/ajt.15204
Matas, Arthur J. ; Fieberg, Ann ; Mannon, Roslyn B. ; Leduc, Robert ; Grande, Joseph Peter ; Kasiske, Bertram L. ; Cecka, Michael ; Gaston, Robert ; Hunsicker, Lawrence ; Connett, John ; Cosio, Fernando G ; Gourishankar, Sita ; Rush, David. / Long-term follow-up of the DeKAF cross-sectional cohort study. In: American Journal of Transplantation. 2019.
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