Glomerular damage as a predictor of renal allograft loss

• Published in: Brazilian journal of medical and biological research 2010-06, Vol.43 (6), p.557-564
• Main Authors: Moscoso-Solorzano, G, Câmara, N O S, Franco, M F, Araújo, S, Ortega, F, Pacheco-Silva, A, Mastroianni-Kirsztajn, G
• Format: Article
• Language: English
• Subjects: Adult; Atrophy - pathology; BIOLOGY; Chronic allograft nephropathy; Chronic Disease; Female; Fibrosis; Glomerulonephritis; Graft Rejection - pathology; Graft Rejection - prevention & control; Humans; Immunosuppressive Agents - therapeutic use; Kidney Glomerulus - pathology; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney Tubules - pathology; Male; MEDICINE, RESEARCH & EXPERIMENTAL; Predictive Value of Tests; Retrospective Studies; Risk Factors; Transplant glomerulopathy
• ISSN: 0100-879X; 1414-431X; 1414-431X; 0100-879X
• DOI: 10.1590/S0100-879X2010007500039

Interstitial fibrosis and tubular atrophy (IF/TA) are the most common cause of renal graft failure. Chronic transplant glomerulopathy (CTG) is present in approximately 1.5-3.0% of all renal grafts. We retrospectively studied the contribution of CTG and recurrent post-transplant glomerulopathies (RGN) to graft loss. We analyzed 123 patients with chronic renal allograft dysfunction and divided them into three groups: CTG (N = 37), RGN (N = 21), and IF/TA (N = 65). Demographic data were analyzed and the variables related to graft function identified by statistical methods. CTG had a significantly lower allograft survival than IF/TA. In a multivariate analysis, protective factors for allograft outcomes were: use of angiotensin-converting enzyme inhibitor (ACEI; hazard ratio (HR) = 0.12, P = 0.001), mycophenolate mofetil (MMF; HR = 0.17, P = 0.026), hepatitis C virus (HR = 7.29, P = 0.003), delayed graft function (HR = 5.32, P = 0.016), serum creatinine > or =1.5 mg/dL at the 1st year post-transplant (HR = 0.20, P = 0.011), and proteinuria > or =0.5 g/24 h at the 1st year post-transplant (HR = 0.14, P = 0.004). The presence of glomerular damage is a risk factor for allograft loss (HR = 4.55, P = 0.015). The presence of some degree of chronic glomerular damage in addition to the diagnosis of IF/TA was the most important risk factor associated with allograft loss since it could indicate chronic active antibody-mediated rejection. ACEI and MMF were associated with better outcomes, indicating that they might improve graft survival.