Abstract: TH-PO1008

Uncovering the Association between Early Histological Features of Diabetic Kidney Disease and Renal Allograft Outcomes

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Cho, Jacob, Stony Brook Medicine, Stony Brook, New York, United States
  • Estrada, Chelsea C., Stony Brook Medicine, Stony Brook, New York, United States
  • Mallipattu, Sandeep K., Stony Brook Medicine, Stony Brook, New York, United States
Background

Diabetes Mellitus is a risk factor for worse renal allograft survival, but patients typically do not lose their allograft due to diabetic kidney disease (DKD). However, it remains unclear whether early diabetic changes in the transplanted kidney are associated with worse outcomes. The objective of this pilot study is to determine whether histological features consistent with early DKD are predictive of subsequent graft loss.

Methods

We reviewed consecutive, clinically indicated, renal allograft biopsies performed at Stony Brook University Hospital from 2010 to 2015. Biopsies with either mesangial matrix expansion (MME) or thickened basement membrane (TBM) were classified as early DKD (eDKD). Patients with a final diagnosis of transplant glomerulopathy (TG) or overt DKD were excluded. Graft failure, creatinine, and eGFR were also collected at 6 months, 1 year and 2 years post biopsy. All data was assessed for normality, and then parametric or non-parametric tests were employed for data analysis.

Results

In total, 247 renal transplant biopsies were reviewed. Biopsies were performed at a mean of 3.98 ± 0.93 years post-transplantation. In total, 83 were excluded for either overt DKD or TG. Of the remaining 164 biopsies, 89 (54.2%) were classified as eDKD and the rest (45.7%) as non-diabetic kidney disease (NDKD). Baseline demographics for the two groups are in Table 1. Mean HbA1C was 6.0 ± 0.1% in the eDKD group and 6.2 ± 0.2% in the NDKD group. In all, 25/89 (28.1%) patients in the eDKD had graft failure at a mean of 0.9 years post biopsy, as compared with 16/75 (21.3%) patients in the NDKD group (p= 0.368).

Conclusion

In this small cohort, these data suggest there is a trend towards worse renal allograft outcomes in patients with early histological features of DKD. Further analysis of eGFR trends and a larger sample size are required to determine the significance of early DKD changes on allograft outcomes.

Table 1