INTRODUCTION. Late chronic allograft disfunction (CAD) is one of the more concerning issues in the management of patients (pts) with renal transplant (tx). Humoral immune response seems to play an important role in CAD pathogenesis.
AIM OF THE STUDY. To identify the causes of late chronic allograft disfunction.
METHODS. This study (march 2004-august 2011) enrolled pts who underwent renal biopsy (BR) because of CAD (increase of creatininemia (s-Cr) >30% and/or proteinuria >1g/day at least one year after tx). BR were classified according to 1997/2005 Banff classification. Histological evaluation of C4d (positive if >25%), glomerulitis, tubulitis, intimal arteritis, atrophy/fibrosis and arteriolar-hyalinosis were performed. Ab anti-HLA research at BR was an inclusion criteria. Pts were divided into two groups: with or without transplant glomerulopathy (CTG).
RESULTS. Evaluated BR: 93/109. BR indication: impaired s-Cr (52/93), proteinuria (23/93), both (18/93). Time Tx-BR: 7.4±6.3 yrs; s-Cr at BR: 2.7±1.4 mg/dl.
CTG group(n=49) not-CTG group(n=44) p
Time tx-BR (yrs) 9.3±6.7 5.3±5.2 0.002
Follow-up post-BR (yrs) 2.7±1.8 4.1±1.4 0.0001
s-Cr at BR (mg/dl) 2.9±1.3 2.4±1.5 NS
Rate (%) of pts:
Proteinuria at BR 61% 25% 0.0004
C4d+ 84% 25% <0.0001
Ab anti-HLA+ 71% 30% 0.0001
C4d+ and/or Ab antiHLA 92% 43% 0.0001
Glomerulitis 76% 16% <0.0001
Tubulitis 6% 32% 0.0014
Intimal arteritis 18% 0% 0.002
Arteriolar hyalinosis 65% 50% NS
Atrophy/fibrosis 80% 77% NS
Graft survival 45% 86% 0.00005
Histological Diagnosis:
CTG group (n=49:Chronic rejection 94%;IgA recurrence + humoral activity 4%;IIA acute rejection + humoral activity 2%. Not-CTG group (n=44: GN recurrence 27%;IF/TA 23%; acute rejection 23%;BKV nephritis 9%; mild not specific alterations 18%.
CONCLUSIONS: CTG is the morphological lesion mainly related to CAD. In the 92% of the cases it is associated with markers of immunological activity. It causes graft failure within five years after diagnosis in 55% of pts.
| Identifer | oai:union.ndltd.org:unibo.it/oai:amsdottorato.cib.unibo.it:4702 |
| Date | 28 June 2012 |
| Creators | Valerio, Francesca <1978> |
| Contributors | Stefoni, Sergio |
| Publisher | Alma Mater Studiorum - Università di Bologna |
| Source Sets | Università di Bologna |
| Language | Italian |
| Detected Language | English |
| Type | Doctoral Thesis, PeerReviewed |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess |
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