Morphologic Patterns and Treatment of Transplant Glomerulopathy: a Retrospective Analysis

• Autor(a) principal: Abreu, R
• Data de Publicação: 2017
• Outros Autores: Carvalho, F, Viana, H, Mesquita, I, Possante, M, Aires, I, Caeiro, F, Silva, C, Cotovio, P, Ferreira, A, Remédio, F, Nolasco, F
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.17/3832
• topic: HCC NEF; Adult; Female; Male; Humans; Follow-Up Studies; Middle Aged; Glomerular Filtration Rate; Glomerulonephritis / etiology; Glomerulonephritis / pathology; Glomerulonephritis / therapy; Graft Rejection / etiology; Graft Rejection / pathology; Graft Rejection / therapy; Graft Survival; Isoantibodies / blood; Isoantibodies / immunology; Kidney Failure, Chronic / surgery; Kidney Function Tests; Kidney Glomerulus / pathology; Kidney Transplantation / adverse effects; Postoperative Complications; Prognosis; Risk Factors; Retrospective Studies

Transplant glomerulopathy is mainly due to chronic antibody-mediated rejection and actually represents a major cause of long-term allograft failure. The lack of effective treatment remains a serious problem in transplantation. A retrospective and uni-center study was performed in 48 kidney allograft recipients with transplant glomerulopathy between January 2010 and December 2015. Median time for diagnosis was 7.1 (3.6-11.8) years post-transplant. Light microscopy showed severity of transplant glomerulopathy in the majority of patients (cg1=10.4%; cg2=20.8%; cg3=68.8%). Moderate microvascular inflammation was present in 56.3% (g+ptc≥2), and almost half of recipients (51.1%) were C4d positive in immunofluorescence. Female gender (P=.001), age (P=.043), renal dysfunction (P=.002), acute rejection episodes (P=.026), and anti-HLA class II antibodies (P=.004) were associated with kidney allograft failure. Treatment of transplant glomerulopathy was performed in 67.6% of patients. The histologic and laboratory features that led to a therapeutic intervention were score ptc (P=.021), C4d (P=.03), and the presence of anti-HLA antibodies (P=.029), whereas score ah (P=.005) was associated with conservative measure. The overall cumulative kidney allograft survival at 10 years was 75%. Treatment of transplant glomerulopathy was ineffective to improve long-term kidney allograft survival.