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Background: Transplant glomerulopathy (TG) is one of the main causes of post-transplant proteinuria (PU). The features and possible risk factors for proteinuria in TG patients are uncertain.
Methods: We investigated all patients who had biopsy-proven TG from 2000 to 2018 in our center. The clinical and histological data were compared between two gr...
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Context 1
... level of proteinuria best correlated with Banff lesion score cg (Spearman's ρ = 0.231, P = 0.003) and mm (ρ = 0.194, P = 0.012), whereas the interstitial fibrosis/tubular atrophy scores, C4d scores (ρ = 0.045, P = 0.1), and cv (ρ = 0.008, P = 0.915) were unrelated (Figure 3). None of Banff lesion scores showed positive result in univariable regression analysis of proteinuria (Table 4). Positive C4d staining was found to be a significant pathologic risk factor for proteinuria as determined by multivariable regression analysis (Figure 4). ...Citations
... All data including estimated glomerular filtration rate (GFR, ml/min), proteinuria (mg/g creatinine), delayed graft function (DGF), defined as the need for dialysis within 7 days of transplant, and biopsy data were collected from the prospectively maintained database (TBase) (49). All rejections were categorized according to Banff 2017 classification (5, 50,51). Calculated panel-reactive antibody (cPRA) was obtained through the Virtual PRA Calculator of the Eurotransplant Reference Laboratory. 1 No institutional review board approval was required for this retrospective analysis. ...
Background
De novo donor-specific HLA antibodies (dnDSA) are key factors in the diagnosis of antibody-mediated rejection (ABMR) and related to graft loss.
Methods
This retrospective study was designed to evaluate the natural course of dnDSA in graft function and kidney allograft survival and to assess the impact of mean fluorescence intensity (MFI) evolution as detected by annual Luminex ® screening. All 400 kidney transplant recipients with 731 dnDSA against the last graft (01/03/2000-31/05/2021) were included.
Results
During 8.3 years of follow-up, ABMR occurred in 24.8% and graft loss in 33.3% of the cases, especially in patients with class I and II dnDSA, and those with multiple dnDSA. We observed frequent changes in MFI with 5-year allograft survivals post-dnDSA of 74.0% in patients with MFI reduction ≥ 50%, 62.4% with fluctuating MFI (MFI reduction ≥ 50% and doubling), and 52.7% with doubling MFI (log-rank p < 0.001). Interestingly, dnDSA in 168 (24.3%) cases became negative at some point during follow-up, and 38/400 (9.5%) patients became stable negative, which was associated with better graft survival. Multivariable analysis revealed the importance of MFI evolution and rejection, while class and number of dnDSA were not contributors in this model.
Conclusion
In summary, we provide an in-depth analysis of the natural course of dnDSA after kidney transplantation, first evidence for the impact of MFI evolution on graft outcomes, and describe a relevant number of patients with a stable disappearance of dnDSA, related to better allograft survival.
