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Transplant Glomerulopathy: Subclinical Incidence and Association with Alloantibody

Gloor, J. M. ; Sethi, S. ; Stegall, M. D. ; Park, W. D. ; Moore, S. B. ; DeGoey, S. ; Griffin, M. D. ; Larson, T. S. ; Cosio, F. G.

American journal of transplantation, 2007-09, Vol.7 (9), p.2124-2132 [Periódico revisado por pares]

Oxford, UK: Blackwell Publishing Ltd

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Título:
Transplant Glomerulopathy: Subclinical Incidence and Association with Alloantibody
Autor: Gloor, J. M. ; Sethi, S. ; Stegall, M. D. ; Park, W. D. ; Moore, S. B. ; DeGoey, S. ; Griffin, M. D. ; Larson, T. S. ; Cosio, F. G.
Assuntos: Alloantibodies ; Autoantibodies - immunology ; Biological and medical sciences ; Biopsy ; chronic allograft nephropathy (CAN) ; chronic transplant glomerulopathy ; Disease Progression ; Epidemiology ; Fluorescent Antibody Technique ; Follow-Up Studies ; General aspects ; Glomerulonephritis, Membranous - epidemiology ; Glomerulonephritis, Membranous - immunology ; Glomerulonephritis, Membranous - pathology ; Graft Rejection - epidemiology ; Graft Rejection - immunology ; Graft Rejection - pathology ; HLA Antigens - immunology ; Humans ; humoral rejection ; Incidence ; Kidney - ultrastructure ; Kidney Transplantation - immunology ; Medical sciences ; Microscopy, Electron ; Middle Aged ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Prognosis ; protocol biopsies ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Renal failure ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; transplant glomerulopathy ; Transplantation, Homologous
É parte de: American journal of transplantation, 2007-09, Vol.7 (9), p.2124-2132
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
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Descrição: Transplant glomerulopathy (TG) usually has been described as part of a constellation of late chronic histologic abnormalities associated with proteinuria and declining function. The current study used both protocol and clinically‐indicated biopsies to investigate clinical and subclinical TG, their prognosis and possible association with alloantibody. We retrospectively studied 582 renal transplants with a negative pre‐transplant T‐cell complement dependent cytotoxicity crossmatch. TG was diagnosed in 55 patients, 27 (49%) based on protocol biopsy in well‐functioning grafts. The cumulative incidence of TG increased over time to 20% at 5 years. The prognosis of subclinical TG was equally as poor as TG diagnosed with graft dysfunction, with progressive worsening of histopathologic changes and function. Although TG was associated with both acute and chronic histologic abnormalities, 14.5% of TG biopsies showed no interstitial fibrosis or tubular atrophy, while 58% (7/12) of biopsies with severe TG showed only minimal abnormalities. TG was associated with acute rejection, pretransplant hepatitis C antibody positivity and anti‐HLA antibodies (especially anti‐Class II), with the risk increasing if the antibodies were donor specific. We suggest that subclinical TG is an under‐recognized cause of antibody‐mediated, chronic renal allograft injury which may be mechanistically distinct from other causes of nephropathy. Transplant glomerulopathy is often detected on biopsies showing minimal histologic abnormalities otherwise, and is highly associated with anti‐HLA class II antibodies present at transplant indicating that antibody‐mediated injury is an important cause of transplant glomerulopathy.
Editor: Oxford, UK: Blackwell Publishing Ltd
Idioma: Inglês

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Transplant Glomerulopathy: Subclinical Incidence and Association with Alloantibody

Gloor, J. M. ; Sethi, S. ; Stegall, M. D. ; Park, W. D. ; Moore, S. B. ; DeGoey, S. ; Griffin, M. D. ; Larson, T. S. ; Cosio, F. G.

Oxford, UK: Blackwell Publishing Ltd

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