Decreased Kidney Graft Survival in Low Immunological Risk Patients Showing Inflammation in Normal Protocol Biopsies

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http://hdl.handle.net/10138/167369

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Ortiz , F , Gelpi , R , Helanterä , I , Melilli , E , Honkanen , E , Bestard , O , Grinyo , J M & Cruzado , J M 2016 , ' Decreased Kidney Graft Survival in Low Immunological Risk Patients Showing Inflammation in Normal Protocol Biopsies ' , PLoS One , vol. 11 , no. 8 , 0159717 . https://doi.org/10.1371/journal.pone.0159717

Title: Decreased Kidney Graft Survival in Low Immunological Risk Patients Showing Inflammation in Normal Protocol Biopsies
Author: Ortiz, Fernanda; Gelpi, Rosana; Helanterä, Ilkka; Melilli, Edoardo; Honkanen, Eero; Bestard, Oriol; Grinyo, Josep M.; Cruzado, Josep M.
Contributor organization: Nefrologian yksikkö
Department of Medicine
Clinicum
Date: 2016-08-17
Language: eng
Number of pages: 14
Belongs to series: PLoS One
ISSN: 1932-6203
DOI: https://doi.org/10.1371/journal.pone.0159717
URI: http://hdl.handle.net/10138/167369
Abstract: Introduction The pros and cons for implementing protocol biopsies (PB) after kidney transplantation are still a matter of debate. We aimed to address the frequency of pathological findings in PB, to analyze their impact on long-term graft survival (GS) and to analyze the risk factors predicting an abnormal histology. Methods We analyzed 946 kidney PB obtained at a median time of 6.5 (+/- 2.9) months after transplantation. Statistics included comparison between groups, Kaplan-Meier and multinomial logistic regression analysis. Results and Discussion PB diagnosis were: 53.4% normal; 46% IFTA; 12.3% borderline and 4.9% had subclinical acute rejection (SCAR). Inflammation had the strongest negative impact on GS. Therefore we split the cases into: "normal without inflammation", "normal with inflammation", "IFTA without inflammation", "IFTA with inflammation" and "rejection" (including SCAR and borderline). 15-year GS in PB diagnosed normal with inflammation was significantly decreased in a similar fashion as in rejection cases. Among normal biopsies, inflammation increased significantly the risk of 15-y graft loss (P = 0.01). Variables that predicted an abnormal biopsy were proteinuria, previous AR and DR-mismatch. Conclusion We conclude that inflammation in normal PB is associated with a significantly lower 15-y GS, comparable to rejection or IFTA with inflammation.
Subject: EARLY SUBCLINICAL REJECTION
RENAL-ALLOGRAFT REJECTION
TUBULAR ATROPHY
TRANSPLANT RECIPIENTS
INTERSTITIAL FIBROSIS
SURVEILLANCE BIOPSIES
PROTEINURIA
CLASSIFICATION
CONSEQUENCES
MANAGEMENT
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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