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Long-term kidney allograft survival in patients with transplant glomerulitis.
Transplantation. 2015 Feb; 99(2):331-9.T

Abstract

BACKGROUND

Renal transplant glomerulitis (G) is associated with acute antibody-mediated rejection (ABMR) in the presence of donor-specific antibodies. However, the long-term prognosis of isolated G (isG) in the absence of donor-specific antibodies or G in combination with T cell-mediated rejection (TCMR) remains unexplored.

METHODS

Seventy recipients with G were included in this retrospective study and subdivided into 3 groups: isG, G with TCMR (G+TCMR), and G with acute ABMR. The control groups were: patients with TCMR Banff type I or II without G (TCMR) and patients without rejection (NR). Kaplan-Meier death-censored survival plots and Cox regression were used to analyze graft survival. The combined graft survival endpoint was defined as a return to dialysis or estimated glomerular filtration rate less than 15 mL/min/1.73 m. The median follow-up was 37 (14; 77) months from biopsy.

RESULTS

Graft survival was significantly lower in patients with G than in the NR and TCMR groups. No significant differences were observed among the isG, G+TCMR, and ABMR groups. Graft survival was lower in the G+TCMR group than in the TCMR group. Glomerulitis was independently associated with the risk of adverse graft outcome in a multivariate Cox regression model adjusted for other confounders (hazard ratio, 4.52 [95% confidence interval, 2.37-8.68] vs controls; P<0.001).

CONCLUSIONS

Glomerulitis is strongly associated with increased risk of graft failure. Graft survival in patients with isG that do not meet the Banff criteria for acute/active ABMR and in patients with G accompanying TCMR is comparable to the ABMR group.

Authors+Show Affiliations

1 Department of Nephrology, Nephrology Center of Lower Saxony, Hann. Muenden, Germany. 2 Department of Nephrology, 1st St. Petersburg Pavlov State Medical University, St. Petersburg, Russian Federation. 3 Department of Cellular and Molecular Pathology, German Cancer Research Center, Heidelberg, Germany. 4 Institute for Transfusion Medicine, Hannover Medical School, Hannover, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25594551

Citation

Nabokow, Alexander, et al. "Long-term Kidney Allograft Survival in Patients With Transplant Glomerulitis." Transplantation, vol. 99, no. 2, 2015, pp. 331-9.
Nabokow A, Dobronravov VA, Khrabrova M, et al. Long-term kidney allograft survival in patients with transplant glomerulitis. Transplantation. 2015;99(2):331-9.
Nabokow, A., Dobronravov, V. A., Khrabrova, M., Gröne, H. J., Gröne, E., Hallensleben, M., Kieneke, D., Weithofer, P., Smirnov, A. V., & Kliem, V. (2015). Long-term kidney allograft survival in patients with transplant glomerulitis. Transplantation, 99(2), 331-9. https://doi.org/10.1097/TP.0000000000000606
Nabokow A, et al. Long-term Kidney Allograft Survival in Patients With Transplant Glomerulitis. Transplantation. 2015;99(2):331-9. PubMed PMID: 25594551.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term kidney allograft survival in patients with transplant glomerulitis. AU - Nabokow,Alexander, AU - Dobronravov,Vladimir A, AU - Khrabrova,Maria, AU - Gröne,Hermann-Josef, AU - Gröne,Elisabeth, AU - Hallensleben,Michael, AU - Kieneke,Daniela, AU - Weithofer,Peter, AU - Smirnov,Alexei V, AU - Kliem,Volker, PY - 2015/1/17/entrez PY - 2015/1/17/pubmed PY - 2015/6/16/medline SP - 331 EP - 9 JF - Transplantation JO - Transplantation VL - 99 IS - 2 N2 - BACKGROUND: Renal transplant glomerulitis (G) is associated with acute antibody-mediated rejection (ABMR) in the presence of donor-specific antibodies. However, the long-term prognosis of isolated G (isG) in the absence of donor-specific antibodies or G in combination with T cell-mediated rejection (TCMR) remains unexplored. METHODS: Seventy recipients with G were included in this retrospective study and subdivided into 3 groups: isG, G with TCMR (G+TCMR), and G with acute ABMR. The control groups were: patients with TCMR Banff type I or II without G (TCMR) and patients without rejection (NR). Kaplan-Meier death-censored survival plots and Cox regression were used to analyze graft survival. The combined graft survival endpoint was defined as a return to dialysis or estimated glomerular filtration rate less than 15 mL/min/1.73 m. The median follow-up was 37 (14; 77) months from biopsy. RESULTS: Graft survival was significantly lower in patients with G than in the NR and TCMR groups. No significant differences were observed among the isG, G+TCMR, and ABMR groups. Graft survival was lower in the G+TCMR group than in the TCMR group. Glomerulitis was independently associated with the risk of adverse graft outcome in a multivariate Cox regression model adjusted for other confounders (hazard ratio, 4.52 [95% confidence interval, 2.37-8.68] vs controls; P<0.001). CONCLUSIONS: Glomerulitis is strongly associated with increased risk of graft failure. Graft survival in patients with isG that do not meet the Banff criteria for acute/active ABMR and in patients with G accompanying TCMR is comparable to the ABMR group. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/25594551/Long_term_kidney_allograft_survival_in_patients_with_transplant_glomerulitis_ L2 - http://dx.doi.org/10.1097/TP.0000000000000606 DB - PRIME DP - Unbound Medicine ER -