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Kidney Week

Abstract: PO2553

Histological Predictors of Graft Failure in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Ajaimy, Maria, Montefiore Medical Center, Bronx, New York, United States
  • Al Azzi, Yorg, Montefiore Medical Center, Bronx, New York, United States
  • Nandigam, Purna Bindu, Montefiore Medical Center, Bronx, New York, United States
  • Loarte Campos, Pablo, Montefiore Medical Center, Bronx, New York, United States
  • Pynadath, Cindy T., Montefiore Medical Center, Bronx, New York, United States
  • Liriano-Ward, Luz E., Montefiore Medical Center, Bronx, New York, United States
  • Akalin, Enver, Montefiore Medical Center, Bronx, New York, United States

We aimed to identify the predictors of allograft failure in a large cohort of kidney recipients who underwent clinically indicated graft biopsies. We aimed to explore the importance of interstitial inflammation in biopsies with interstitial fibrosis and tubular atrophy(IFTA).


We retrospectively evaluated 516 patients who underwent transplant biopsy between 1/2009 and 1/2018. Acute and chronic allograft injury scores of Banff classification were used. We sub grouped the patients with chronic allograft injury score (ci+ct+cv) ≥ 3 or< 3 and sub grouped per interstitial inflammation (i score=0 and > 0)and compared to biopsies with both ci+ct+cv=0 and i=0.


Biopsies were done at a median 12.5 months after kidney transplantation.The histopathological diagnosis were as following: acute antibody-mediated rejection (AMR) (6%), acute T-cell mediated rejection (9.3%), chronic AMR (6.7%), transplant glomerulopathy without donor-specific antibody (DSA) (10.2%), recurrent/de novo glomerular disease (10.8%), BKV nephropathy (2.5%), and the rest 54.2% had other diagnosis (normal, acute tubular necrosis,or non-specific IFTA). During a median follow up of 59.3 months after kidney biopsy, 36 %recipients lost their graft. In univariate analysis, the following factors were significant for graft loss: Black race (p=0.005), previous rejection (p<0.0001), DSA at the time of biopsy (p=0.014), ci+ct+cv ≥ 3 (p=0.0485), ci+ct+cv ≥ 3 with interstitial inflammation > 0 ( p<0.0001), microvascular inflammation (p=0.0052), C4d positivity ( p=0.008), serum creatinine at time of the biopsy (p<0.0001), and spot urine protein/creatinine (<0.0001). In the multivariate analysis ci+ct+cv < 3 with i>0 has the highest hazard ratio followed by ci+ct+cv ≥ 3 with i>0, ci+ct+cv ≥ 3 with i=0, black race, creatinine, and proteinuria.


Interstitial inflammation is the best predictor for allograft loss after clinically indicated kidney biopsy regardless of the severity of chronic allograft injury score.

Risk FactorHR95% CIP-value
ci+ct+cv < 3 with i>08.383.22 – 21.78<0.0001
ci+ct+cv ≥ 3 with i>02.921.47-5.82<0.0001
ci+ct+cv ≥ 3 with i=02.691.33-5.44<0.0001
Black Race2.041.43-2.89<0.0001
Serum Creatinine1.271.18-1.37<0.0001
Spot urine protein/creatinine1.111.06-1.17<0.0001