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| Flow chart of patients enrolled in this study. CCM, Charite Campus Mitte; CVK, Charite Virchow Klinikum. FSGS, focal segmental glomerulosclerosis; IgAN, IgA nephropathy; PGN, membranous proliferative glomerulonephritis; membranos GN, membranous glomerulopathy; iTG, solated transplant glomerulopathy; cAMR, chronic antibody-mediated rejection; cAAMR, chronic active antibody-mediated rejection.
Source publication
Background
Transplant glomerulopathy (TG) may indicate different disease entities including chronic AMR (antibody-mediated rejection). However, AMR criteria have been frequently changed, and long-term outcomes of allografts with AMR and TG according to Banff 2017 have rarely been investigated.
Methods
282 kidney allograft recipients with biopsy-pr...
Context in source publication
Context 1
... Jan, 2000 andDec, 2019, TG according to Banff 2017 (12) was found in 665 out of 7146 indication biopsies from 494 kidney allograft recipients. 146 patients were excluded because of missing HLA examinations at time of biopsy, 44 patients had incomplete data or were lost to follow-up shortly after biopsy, 21 patients had recurrent or de novo glomerulonephritis; finally, 282 patients with biopsy-proven TG were identified and included into this retrospective study (Figure 1). ...
Citations
Antibody-mediated rejection (AMR) is the major cause of graft loss in kidney transplant recipients. The Banff classification defines two classes of AMR, active and chronic active but over time this classification has become increasingly complex. To simplify the approach to AMR, we developed activity and chronicity indices based on kidney transplant biopsy findings and examined their association with graft survival in 147 patients with active or chronic active AMR, all of whom had donor-specific antibodies and were treated for AMR. The activity index was determined as the sum of Banff glomerulitis (g), peritubular capillaritis (ptc), arteritis (v) and C4d scores, with a maximum score of 12. The chronicity index was the sum of interstitial fibrosis (ci), tubular atrophy (ct), chronic vasculopathy (cv), and chronic glomerulopathy (cg) scores, the latter doubled, with a maximum score of 15. While the activity index was generally not associated with graft loss, the chronicity index was significantly associated with graft loss with an optimal threshold value of 4 or greater for predicting graft loss. The association of the chronicity index of 4 or greater with graft loss was independent of other parameters associated with graft loss, including the estimated glomerular filtration rate at the time of biopsy, chronic active (versus active) AMR, AMR with de novo (versus persistent/rebound) donor-specific antibodies, Banff (g+ptc) scores, concurrent T cell mediated rejection and donor-specific antibody reduction post-biopsy. The association of the chronicity index of 4 or greater with graft loss was confirmed in an independent cohort of 61 patients from Necker Hospital, Paris. Thus, our findings suggest the chronicity index may be valuable as a simplified approach to decision-making in patients with AMR.
