Transplantation Direct (Oct 2022)

Impact of Glomerulitis on Long-term Outcomes After Kidney Transplantation

  • Morgan Whigham, MD,
  • Raymond L. Heilman, MD,
  • Sumi Sukumaran Nair, MBBS, MD,
  • Matthew R. Buras, MS,
  • Elisabeth S. Lim, MPH,
  • Andres Jaramillo, PhD,
  • Daniel S. Ramon, PhD,
  • Margaret S. Ryan, MD,
  • Girish K. Mour, MBBS, MD

DOI
https://doi.org/10.1097/TXD.0000000000001381
Journal volume & issue
Vol. 8, no. 10
p. e1381

Abstract

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Background. The Banff classification scheme provides a framework for interpreting transplant kidney biopsies and has undergone various updates in the past 2 decades especially related to antibody-mediated rejection. The clinical significance of early glomerulitis seen within 4 mo on protocol biopsies has received limited attention. We hypothesized that early glomerulitis seen on protocol biopsies will lead to significant adverse outcomes as assessed by histopathology and allograft outcome. Methods. A single-center retrospective study of a cohort of patients who underwent protocol biopsies within 4 mo after transplantation with timely follow-up protocol biopsies were assessed. Patients with recurrent glomerulonephritis were excluded. Results. We calculated glomerulitis (g) scores for 2212 biopsy specimens and identified 186 patients with glomerulitis (g > 0) and 2026 patients without glomerulitis (g = 0). The progression to chronic transplant glomerulopathy at 1 and 2 y was higher in patients with g > 0 as compared with g = 0 (year 1, 10.7% versus 2.3% [P 0 as compared with g = 0 (hazard ratio, 1.68 [95% CI, 1.07-2.65]; P = 0.02). We did not find any difference in outcomes in glomerulitis group based on donor-specific antibody. Conclusion. Our findings suggest that early glomerulitis (seen within 4 mo after transplantation) may lead to clinically significant long-term changes and thus could be a target for early intervention therapies.