Kidney Week

Abstract: TH-PO1060

Stenosis of the Glomerulotubular Neck in Kidney Allografts Is Associated with Graft Failure

Session Information

• Transplantation: Clinical - Outcomes, Malignancy, and Pathology
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Lin, Jiaxin, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Jiaxin Lin, MBBS, PhD

• Gibson, Ian W., University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada

Ian W. Gibson, MD, MBChB

• Vitoriano, Jessica Eleuterio, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, United States

Jessica Eleuterio Vitoriano, MD

• Mullan, Aidan F., Mayo Clinic Alix School of Medicine, Rochester, Minnesota, United States

Aidan F. Mullan, MA

• Denic, Aleksandar, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, United States

Aleksandar Denic, MD, PhD

• Rule, Andrew D., Mayo Clinic Alix School of Medicine, Rochester, Minnesota, United States

Andrew D. Rule, MD, MS, FASN

• Cohen, Eric P., New York University Grossman School of Medicine, New York, New York, United States

Eric P. Cohen, MD

Background

We have previously shown that glomerulotubular neck stenosis (GTNS) is associated with progressive chronic kidney disease after radical nephrectomy. The risk of graft failure with GTNS in kidney allografts has not been formally studied.

Methods

In this age- and sex-matched case-control study of kidney transplant recipients, we assessed whether GTNS on 5-year protocol allograft biopsies associated with a subsequent risk of graft failure. Digital images of serial sections from surveillance biopsies were assessed for glomerulotubular necks with and without stenosis. Additional morphological features at the tubular pole included periglomerular fibrosis (PGF), interstitial fibrosis (IF), reduplication of Bowman’s capsule and tubular basement membrane, and ischemic tuft contraction.

Results

There were 30 cases that developed graft failure with a mean of 6.4 necks per case and 60 matched controls with a mean 7.7 necks per case. Considering all necks across all patients, 49/192 (25.5%) necks were stenotic in the cases vs. 59/461 (12.8%) in the controls. Each 5% increase in stenotic necks was associated with graft failure (OR 1.14, p=0.007), but not after adjustment for percentage of interstitial fibrosis and tubular atrophy (%IFTA) (OR 1.06, p=0.30). Among necks with associated IF, 39/58 (67 %) were stenotic in the cases group vs. 37/100 (37 %) in the controls (p=0.0009); adjusted OR = 1.11 (95% CI: 1.03–1.21, p=0.007). Among necks with ischemic tuft contraction, 24/34 (71 %) were stenotic in the cases vs. 17/66 (26 %) in the controls (p=0.0003); adjusted OR = 1.17 (95% CI: 1.08–1.30, p=0.0007). GTNS with concurrent PGF, reduplication of Bowman’s capsule, or tubular basement membrane changes was not associated with graft failure.

Conclusion

Glomerulotubular neck stenosis accompanied by interstitial fibrosis or ischemic tuft contraction is associated with kidney allograft failure.

Funding

• NIDDK Support