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Abstract: FR-OR136

Archetype Analysis Identifies Distinct Profiles in Renal Transplant Recipients with Transplant Glomerulopathy Associated with Allograft Survival

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Bouatou, Yassine R., Paris Translational Research Center for Organ Transplantation, Paris, France
  • Aubert, Olivier, Paris Translational Research Center for Organ Transplantation, Paris, France
  • Higgins, Sarah, Université de Sherbrooke, Sherbrooke, Quebec, Canada
  • Viglietti, Denis, Paris Translational Research Center for Organ Transplantation, Paris, France
  • Lefaucheur, Carmen, Paris Translational Research Center for Organ Transplantation, Paris, France
  • Loupy, Alexandre, Paris Translational Research Center for Organ Transplantation, Paris, France
Background

Transplant glomerulopathy (TG) is a common glomerular lesion observed after kidney transplantation and a well-known contributing factor for allograft loss. However, overlapping pathways, associated etiologies and clinical courses have not been addressed at a population level.

Methods

All consecutive kidney transplant recipients from 3 referral centers from France and 1 in Canada with a diagnosis of TG (Banff cg score≥1) in biopsies performed between January 2004 and January 2014 were included and assessed by light microscopy, immunohistochemistry, immunofluorescence and electron microscopy. All patients underwent circulating anti-HLA donor-specific antibodies testing at the time of TG diagnosis.

Results

Among the 8,207 post-transplant allograft biopsies performed during the inclusion period in the 4 centers, 552 presented with TG (incidence of 6.7%).The median time to TG diagnosis post-transplant was 33.18 months (IQR: 12.12 – 78.72 months). Kidney allograft survival rates after TG diagnosis were 69.4%, 57.1%, 43.3% and 25.5% at 3, 5, 7 and 10 years, respectively. Unsupervised learning method integrating clinical, functional, immunological and histological parameters revealed 5 TG archetypes characterized by distinct features, and associated etiologies. The 5 TG archetypes unraveled distinct allograft survival profiles with incremental 5-year allograft loss rates between archetypes (Fig 1).

Conclusion

A probabilistic data-driven archetypical approach applied in a large well defined multicentric cohort, refines the diagnostic and prognostic features associated with TG, reducting heterogeneity, which might help improving disease characterization and individual patient risk stratification, opening avenues for an archetype-based strategy for TG treatment.

Figure 1: Kidney allograft survival after TG diagnosis overall (A) and archetype-based (B). The overall difference between the five archetypes was significant (p-value<0.0001).