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Morphologic Patterns and Treatment of Transplant Glomerulopathy: a Retrospective Analysis

2017Journal article Open access
http://hdl.handle.net/10400.17/3832
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Authors

Abreu, R
Carvalho, F
Viana, H
Mesquita, I
Possante, M
Aires, I
Caeiro, F
Silva, C
Cotovio, P
Ferreira, A

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Abstract(s)

Transplant glomerulopathy is mainly due to chronic antibody-mediated rejection and actually represents a major cause of long-term allograft failure. The lack of effective treatment remains a serious problem in transplantation. A retrospective and uni-center study was performed in 48 kidney allograft recipients with transplant glomerulopathy between January 2010 and December 2015. Median time for diagnosis was 7.1 (3.6-11.8) years post-transplant. Light microscopy showed severity of transplant glomerulopathy in the majority of patients (cg1=10.4%; cg2=20.8%; cg3=68.8%). Moderate microvascular inflammation was present in 56.3% (g+ptc≥2), and almost half of recipients (51.1%) were C4d positive in immunofluorescence. Female gender (P=.001), age (P=.043), renal dysfunction (P=.002), acute rejection episodes (P=.026), and anti-HLA class II antibodies (P=.004) were associated with kidney allograft failure. Treatment of transplant glomerulopathy was performed in 67.6% of patients. The histologic and laboratory features that led to a therapeutic intervention were score ptc (P=.021), C4d (P=.03), and the presence of anti-HLA antibodies (P=.029), whereas score ah (P=.005) was associated with conservative measure. The overall cumulative kidney allograft survival at 10 years was 75%. Treatment of transplant glomerulopathy was ineffective to improve long-term kidney allograft survival.

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Keywords

HCC NEF Adult Female Male Humans Follow-Up Studies Middle Aged Glomerular Filtration Rate Glomerulonephritis / etiology Glomerulonephritis / pathology Glomerulonephritis / therapy Graft Rejection / etiology Graft Rejection / pathology Graft Rejection / therapy Graft Survival Isoantibodies / blood Isoantibodies / immunology Kidney Failure, Chronic / surgery Kidney Function Tests Kidney Glomerulus / pathology Kidney Transplantation / adverse effects Postoperative Complications Prognosis Risk Factors Retrospective Studies

URI

http://hdl.handle.net/10400.17/3832

Citation

Clin Transplant. 2017 Apr;31(4). doi: 10.1111/ctr.12915. Epub 2017 Feb 21.

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Publisher

Wiley

DOI

10.1111/ctr.12915.

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NEF - Artigos

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