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Early allograft inflammation and scarring associate with graft dysfunction and poor outcomes in renal transplant recipients with delayed graft function: a prospective single center cohort study.
Transpl Int. 2018 12; 31(12):1369-1379.TI

Abstract

Early histological progression that associates with delayed graft function (DGF) and its relationship to graft outcomes is less well-understood. We systematically evaluated early acute and chronic histological changes associated with DGF through serial biopsies (protocol: 3 and 12 months; for-cause) and related them to graft outcomes. 56/294 (19.04%) of our patients had DGF. DGF was associated with a progressive increase in both Banff 't' and 'i' scores from 2 weeks to 3 and 12 months with a resultant increase in T cell mediated rejection (TCMR) that was significantly greater than those with primary graft function (PGF). This increase in TCMR was predominantly sub-clinical TCMR diagnosed on protocol biopsy. Furthermore, TCMR in patients with DGF was recurrent/persistent at 12 months. Importantly, the combination of DGF and TCMR was associated with significantly worse interstitial fibrosis and tubular atrophy (IFTA) and interstitial fibrosis with inflammation (IF + 'i') as early as 3 months and worse renal function. Finally, DGF with TCMR was associated with significantly worse graft loss. In this regard, DGF without TCMR had comparable chronic histology and outcomes to PGF. Thus, DGF with TCMR (predominantly sub-clinical), represents a high-risk patient group who may benefit from early novel immunosuppression augmentation strategies to improve graft outcomes.

Authors+Show Affiliations

Department of Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30007072

Citation

Cherukuri, Aravind, et al. "Early Allograft Inflammation and Scarring Associate With Graft Dysfunction and Poor Outcomes in Renal Transplant Recipients With Delayed Graft Function: a Prospective Single Center Cohort Study." Transplant International : Official Journal of the European Society for Organ Transplantation, vol. 31, no. 12, 2018, pp. 1369-1379.
Cherukuri A, Mehta R, Sood P, et al. Early allograft inflammation and scarring associate with graft dysfunction and poor outcomes in renal transplant recipients with delayed graft function: a prospective single center cohort study. Transpl Int. 2018;31(12):1369-1379.
Cherukuri, A., Mehta, R., Sood, P., & Hariharan, S. (2018). Early allograft inflammation and scarring associate with graft dysfunction and poor outcomes in renal transplant recipients with delayed graft function: a prospective single center cohort study. Transplant International : Official Journal of the European Society for Organ Transplantation, 31(12), 1369-1379. https://doi.org/10.1111/tri.13318
Cherukuri A, et al. Early Allograft Inflammation and Scarring Associate With Graft Dysfunction and Poor Outcomes in Renal Transplant Recipients With Delayed Graft Function: a Prospective Single Center Cohort Study. Transpl Int. 2018;31(12):1369-1379. PubMed PMID: 30007072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early allograft inflammation and scarring associate with graft dysfunction and poor outcomes in renal transplant recipients with delayed graft function: a prospective single center cohort study. AU - Cherukuri,Aravind, AU - Mehta,Rajil, AU - Sood,Puneet, AU - Hariharan,Sundaram, Y1 - 2018/08/01/ PY - 2018/04/03/received PY - 2018/04/27/revised PY - 2018/07/09/accepted PY - 2018/7/15/pubmed PY - 2019/2/2/medline PY - 2018/7/15/entrez KW - acute rejection KW - delayed graft function KW - graft loss KW - kidney transplantation SP - 1369 EP - 1379 JF - Transplant international : official journal of the European Society for Organ Transplantation JO - Transpl. Int. VL - 31 IS - 12 N2 - Early histological progression that associates with delayed graft function (DGF) and its relationship to graft outcomes is less well-understood. We systematically evaluated early acute and chronic histological changes associated with DGF through serial biopsies (protocol: 3 and 12 months; for-cause) and related them to graft outcomes. 56/294 (19.04%) of our patients had DGF. DGF was associated with a progressive increase in both Banff 't' and 'i' scores from 2 weeks to 3 and 12 months with a resultant increase in T cell mediated rejection (TCMR) that was significantly greater than those with primary graft function (PGF). This increase in TCMR was predominantly sub-clinical TCMR diagnosed on protocol biopsy. Furthermore, TCMR in patients with DGF was recurrent/persistent at 12 months. Importantly, the combination of DGF and TCMR was associated with significantly worse interstitial fibrosis and tubular atrophy (IFTA) and interstitial fibrosis with inflammation (IF + 'i') as early as 3 months and worse renal function. Finally, DGF with TCMR was associated with significantly worse graft loss. In this regard, DGF without TCMR had comparable chronic histology and outcomes to PGF. Thus, DGF with TCMR (predominantly sub-clinical), represents a high-risk patient group who may benefit from early novel immunosuppression augmentation strategies to improve graft outcomes. SN - 1432-2277 UR - https://www.unboundmedicine.com/medline/citation/30007072/Early_allograft_inflammation_and_scarring_associate_with_graft_dysfunction_and_poor_outcomes_in_renal_transplant_recipients_with_delayed_graft_function:_a_prospective_single_center_cohort_study_ L2 - https://doi.org/10.1111/tri.13318 DB - PRIME DP - Unbound Medicine ER -