Abstract: SA-PO459
Outcomes of Kidney Transplant Recipients with G3 Glomerulitis
Session Information
- Transplantation: Balancing Rejection and Infection
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Aziz, Fahad, University of Wisconsin, Madison, Wisconsin, United States
- Parajuli, Sandesh, UW Health, Middleton, Wisconsin, United States
- Zhong, Weixiong, University of Wisconsin Madison, Madison, Wisconsin, United States
- Mandelbrot, Didier A., U of Wisconsin Hospital, Madison, Wisconsin, United States
- Djamali, Arjang, School of Medicine and Public Health, Madison, Wisconsin, United States
Background
Glomerulitis is one of the pathological features of AMR. However, the natural history of kidney allografts with g3 lesions (glomerulitis in >75% of glomeruli) is poorly defined.
Methods
We sought to determine the concomitant immunopathological findings and outcomes in a case series of kidney transplant recipients with g3 lesions.
Results
Thirty seven consecutive kidney transplant recipients with g3 lesions in diagnostic biopsies performed 6.2 ± 6.7 years after transplant were included. At the time of biopsy, mean age was 45.5 years and all patients were on triple therapy with CNI, MPA, and prednisone. The majority were Caucasian (80%), male (60%), and had transplant glomerulopathy (68%). Kidney function and immunopathological findings (mean values) at the time of biopsy are displayed in table 1. Treatment after the biopsy included pulse steroids/IVIG (70%), Rituximab (50%), and plasma exchange (10%). Patients were followed up for a mean of 1.6±1.1 years. The incidence of graft loss and death was 11 (30%) and 3 (10%), respectively. Univariate regression analyses including demographic, functional, and immunohistological variables determined that t score (HR = 2.7, 95%CI: 1.3 to 5.8), ct score (HR = 2.1, 95%Cl: 1.009 to 4.7), Scr (HR = 1.6, 95%CI: 1.1 to 2.2 ), and live donor status (HR = 0.18, 95%Cl: 0.3 to 0.9 ) were significantly associated with graft loss. Multivariate stepwise Cox regression analyses only retained Scr (HR = 1.8, 95%Cl: 1.2 to 2.7 ) and live donor status (HR = 0.14, 95%Cl: 0.02 to 0.8 ). Notably, C4d staining and DSA were not retained as significant predictors.
Conclusion
In this largest case series of patients with g3 lesions, 30% of the grafts were lost with in 2 years. Scr and live donor status were the most important variables associated with graft loss. Future studies are needed to determine preventive and treatment stratagies to improve outcomes in patients with g3 lesions.
Table 1. Kidney function and immunopathological characteristics of 37 patients with G3 lesions
| Serum Creatinine | eGFR | UPC | DSA + | Sum MFI | i | t | v | g | mvi | C4d | ci | ct | cv | cg | Sum Chronicity |
| 2.3 | 42 | 1.6 | 40% | 11000 | 0.4 | 0.3 | 0.4 | 3 | 4 | 0.6 | 1.1 | 1.2 | 0.9 | 1.4 | 4.7 |