Pathologic classification of chronic allograft nephropathy

Pathogenic and prognostic implications

Fernando G Cosio, Ronald P. Pelletier, Daniel D. Sedmak, M. E. Falkenhain, Mitchell L. Henry, Elmahdi A. Elkhammas, E. A. Davies, Ginny L. Bumgardner, Ronald M. Ferguson

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background. After transplantation renal allografts frequently develop interstitial fibrosis and tubular atrophy, and these pathologic changes are the hallmarks of chronic allograft nephropathy (CN). However, the diagnosis of CN has no specific pathogenic implications. In this study we sought to determined whether a subclassification of CN according to vascular pathology correlates with posttransplant events, particularly acute rejection, and graft survival. Methods. A total of 419 patients with moderate to severe CN were subdivided into: (1) transplant arteriopathy (TA, n=233, 56%); (2) arteriolar hyalinosis (AH, n=89, 21%); and (3) no characteristic vascular pathology (IFb, n=97, 23%). Results. Patients with AH differed significantly from patients with TA or IFb in the following parameters: (1) AH was diagnosed later after transplantation (P=0.001); (2) fewer patients with AH had acute rejection (AR) before the diagnosis of CN (P<0.0001). For example, 44% of AH and 75% of TA had AR before CN; (3) patients with AH also had fewer AR episodes than the other two groups (P<0.0001); finally, (4) graft survival was better in patients with AH than in patients with TA (P=0,01 by χ2, P=0.001 by Cox). In contrast, there were no significant differences between patients with TA and IFb. By multivariate analysis the survival of grafts with CN correlated with: (1) serum creatinine at diagnosis (P<0.0001), (2) recipient's weight (P=0.004); (3) presence of FGS or level of proteinuria (P=0.03); and (4) the occurrence of AR after the diagnosis of CN (P<0.0001). Regarding the latter, AR were more common (P=0.007) and more numerous (P=0.005) in patients with TA or IFb than in AH. Conclusions. CN can be classified according to vascular pathology in the majority of cases, and this classification correlates with graft survival. Although some forms of CN are closely associated with the occurrence of AR others are not. This study also uncovered several variables that correlate with the survival of grafts with CN.

Original languageEnglish (US)
Pages (from-to)690-696
Number of pages7
JournalTransplantation
Volume67
Issue number5
StatePublished - Mar 15 1999
Externally publishedYes

Fingerprint

Allografts
Graft Survival
Blood Vessels
Pathology
Proteinuria
Kidney Transplantation
Atrophy
Creatinine
Fibrosis
Multivariate Analysis
Transplantation
Transplants
Weights and Measures

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Cosio, F. G., Pelletier, R. P., Sedmak, D. D., Falkenhain, M. E., Henry, M. L., Elkhammas, E. A., ... Ferguson, R. M. (1999). Pathologic classification of chronic allograft nephropathy: Pathogenic and prognostic implications. Transplantation, 67(5), 690-696.

Pathologic classification of chronic allograft nephropathy : Pathogenic and prognostic implications. / Cosio, Fernando G; Pelletier, Ronald P.; Sedmak, Daniel D.; Falkenhain, M. E.; Henry, Mitchell L.; Elkhammas, Elmahdi A.; Davies, E. A.; Bumgardner, Ginny L.; Ferguson, Ronald M.

In: Transplantation, Vol. 67, No. 5, 15.03.1999, p. 690-696.

Research output: Contribution to journalArticle

Cosio, FG, Pelletier, RP, Sedmak, DD, Falkenhain, ME, Henry, ML, Elkhammas, EA, Davies, EA, Bumgardner, GL & Ferguson, RM 1999, 'Pathologic classification of chronic allograft nephropathy: Pathogenic and prognostic implications', Transplantation, vol. 67, no. 5, pp. 690-696.
Cosio FG, Pelletier RP, Sedmak DD, Falkenhain ME, Henry ML, Elkhammas EA et al. Pathologic classification of chronic allograft nephropathy: Pathogenic and prognostic implications. Transplantation. 1999 Mar 15;67(5):690-696.
Cosio, Fernando G ; Pelletier, Ronald P. ; Sedmak, Daniel D. ; Falkenhain, M. E. ; Henry, Mitchell L. ; Elkhammas, Elmahdi A. ; Davies, E. A. ; Bumgardner, Ginny L. ; Ferguson, Ronald M. / Pathologic classification of chronic allograft nephropathy : Pathogenic and prognostic implications. In: Transplantation. 1999 ; Vol. 67, No. 5. pp. 690-696.
@article{fd5f54da1bd44c3f9e22d8f9d4d5629b,
title = "Pathologic classification of chronic allograft nephropathy: Pathogenic and prognostic implications",
abstract = "Background. After transplantation renal allografts frequently develop interstitial fibrosis and tubular atrophy, and these pathologic changes are the hallmarks of chronic allograft nephropathy (CN). However, the diagnosis of CN has no specific pathogenic implications. In this study we sought to determined whether a subclassification of CN according to vascular pathology correlates with posttransplant events, particularly acute rejection, and graft survival. Methods. A total of 419 patients with moderate to severe CN were subdivided into: (1) transplant arteriopathy (TA, n=233, 56{\%}); (2) arteriolar hyalinosis (AH, n=89, 21{\%}); and (3) no characteristic vascular pathology (IFb, n=97, 23{\%}). Results. Patients with AH differed significantly from patients with TA or IFb in the following parameters: (1) AH was diagnosed later after transplantation (P=0.001); (2) fewer patients with AH had acute rejection (AR) before the diagnosis of CN (P<0.0001). For example, 44{\%} of AH and 75{\%} of TA had AR before CN; (3) patients with AH also had fewer AR episodes than the other two groups (P<0.0001); finally, (4) graft survival was better in patients with AH than in patients with TA (P=0,01 by χ2, P=0.001 by Cox). In contrast, there were no significant differences between patients with TA and IFb. By multivariate analysis the survival of grafts with CN correlated with: (1) serum creatinine at diagnosis (P<0.0001), (2) recipient's weight (P=0.004); (3) presence of FGS or level of proteinuria (P=0.03); and (4) the occurrence of AR after the diagnosis of CN (P<0.0001). Regarding the latter, AR were more common (P=0.007) and more numerous (P=0.005) in patients with TA or IFb than in AH. Conclusions. CN can be classified according to vascular pathology in the majority of cases, and this classification correlates with graft survival. Although some forms of CN are closely associated with the occurrence of AR others are not. This study also uncovered several variables that correlate with the survival of grafts with CN.",
author = "Cosio, {Fernando G} and Pelletier, {Ronald P.} and Sedmak, {Daniel D.} and Falkenhain, {M. E.} and Henry, {Mitchell L.} and Elkhammas, {Elmahdi A.} and Davies, {E. A.} and Bumgardner, {Ginny L.} and Ferguson, {Ronald M.}",
year = "1999",
month = "3",
day = "15",
language = "English (US)",
volume = "67",
pages = "690--696",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Pathologic classification of chronic allograft nephropathy

T2 - Pathogenic and prognostic implications

AU - Cosio, Fernando G

AU - Pelletier, Ronald P.

AU - Sedmak, Daniel D.

AU - Falkenhain, M. E.

AU - Henry, Mitchell L.

AU - Elkhammas, Elmahdi A.

AU - Davies, E. A.

AU - Bumgardner, Ginny L.

AU - Ferguson, Ronald M.

PY - 1999/3/15

Y1 - 1999/3/15

N2 - Background. After transplantation renal allografts frequently develop interstitial fibrosis and tubular atrophy, and these pathologic changes are the hallmarks of chronic allograft nephropathy (CN). However, the diagnosis of CN has no specific pathogenic implications. In this study we sought to determined whether a subclassification of CN according to vascular pathology correlates with posttransplant events, particularly acute rejection, and graft survival. Methods. A total of 419 patients with moderate to severe CN were subdivided into: (1) transplant arteriopathy (TA, n=233, 56%); (2) arteriolar hyalinosis (AH, n=89, 21%); and (3) no characteristic vascular pathology (IFb, n=97, 23%). Results. Patients with AH differed significantly from patients with TA or IFb in the following parameters: (1) AH was diagnosed later after transplantation (P=0.001); (2) fewer patients with AH had acute rejection (AR) before the diagnosis of CN (P<0.0001). For example, 44% of AH and 75% of TA had AR before CN; (3) patients with AH also had fewer AR episodes than the other two groups (P<0.0001); finally, (4) graft survival was better in patients with AH than in patients with TA (P=0,01 by χ2, P=0.001 by Cox). In contrast, there were no significant differences between patients with TA and IFb. By multivariate analysis the survival of grafts with CN correlated with: (1) serum creatinine at diagnosis (P<0.0001), (2) recipient's weight (P=0.004); (3) presence of FGS or level of proteinuria (P=0.03); and (4) the occurrence of AR after the diagnosis of CN (P<0.0001). Regarding the latter, AR were more common (P=0.007) and more numerous (P=0.005) in patients with TA or IFb than in AH. Conclusions. CN can be classified according to vascular pathology in the majority of cases, and this classification correlates with graft survival. Although some forms of CN are closely associated with the occurrence of AR others are not. This study also uncovered several variables that correlate with the survival of grafts with CN.

AB - Background. After transplantation renal allografts frequently develop interstitial fibrosis and tubular atrophy, and these pathologic changes are the hallmarks of chronic allograft nephropathy (CN). However, the diagnosis of CN has no specific pathogenic implications. In this study we sought to determined whether a subclassification of CN according to vascular pathology correlates with posttransplant events, particularly acute rejection, and graft survival. Methods. A total of 419 patients with moderate to severe CN were subdivided into: (1) transplant arteriopathy (TA, n=233, 56%); (2) arteriolar hyalinosis (AH, n=89, 21%); and (3) no characteristic vascular pathology (IFb, n=97, 23%). Results. Patients with AH differed significantly from patients with TA or IFb in the following parameters: (1) AH was diagnosed later after transplantation (P=0.001); (2) fewer patients with AH had acute rejection (AR) before the diagnosis of CN (P<0.0001). For example, 44% of AH and 75% of TA had AR before CN; (3) patients with AH also had fewer AR episodes than the other two groups (P<0.0001); finally, (4) graft survival was better in patients with AH than in patients with TA (P=0,01 by χ2, P=0.001 by Cox). In contrast, there were no significant differences between patients with TA and IFb. By multivariate analysis the survival of grafts with CN correlated with: (1) serum creatinine at diagnosis (P<0.0001), (2) recipient's weight (P=0.004); (3) presence of FGS or level of proteinuria (P=0.03); and (4) the occurrence of AR after the diagnosis of CN (P<0.0001). Regarding the latter, AR were more common (P=0.007) and more numerous (P=0.005) in patients with TA or IFb than in AH. Conclusions. CN can be classified according to vascular pathology in the majority of cases, and this classification correlates with graft survival. Although some forms of CN are closely associated with the occurrence of AR others are not. This study also uncovered several variables that correlate with the survival of grafts with CN.

UR - http://www.scopus.com/inward/record.url?scp=0033558910&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033558910&partnerID=8YFLogxK

M3 - Article

VL - 67

SP - 690

EP - 696

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 5

ER -