Isolated endarteritis and kidney transplant survival: a multicenter collaborative study

Isolated endarteritis of kidney transplants is increasingly recognized. Notably, microarray studies revealed absence of immunologic signatures of rejection in most isolated endarteritis biopsy samples. We investigated if isolated endarteritis responds to rejection treatment and affects kidney transp...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2015-05, Vol.26 (5), p.1216-1227
Main Authors: Sis, Banu, Bagnasco, Serena M, Cornell, Lynn D, Randhawa, Parmjeet, Haas, Mark, Lategan, Belinda, Magil, Alex B, Herzenberg, Andrew M, Gibson, Ian W, Kuperman, Michael, Sasaki, Kotaro, Kraus, Edward S
Format: Article
Language:English
Subjects:
Adult
Biopsy
Clinical Research
Endarteritis - etiology
Endarteritis - pathology
Endarteritis - therapy
Female
Graft Rejection - therapy
Graft Survival
Humans
Kidney - pathology
Kidney Transplantation - adverse effects
Male
Middle Aged
Retrospective Studies
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Summary:Isolated endarteritis of kidney transplants is increasingly recognized. Notably, microarray studies revealed absence of immunologic signatures of rejection in most isolated endarteritis biopsy samples. We investigated if isolated endarteritis responds to rejection treatment and affects kidney transplant survival. We retrospectively enrolled recipients of kidney transplant who underwent biopsies between 1999 and 2011 at seven American and Canadian centers. Exclusion criteria were recipients were blood group-incompatible or crossmatch-positive or had C4d-positive biopsy samples. After biopsy confirmation, patients were divided into three groups: isolated endarteritis (n=103), positive controls (type I acute T cell-mediated rejection with endarteritis; n=101), and negative controls (no diagnostic rejection; n=103). Primary end points were improved kidney function after rejection treatment and transplant failure. Mean decrease in serum creatinine from biopsy to 1 month after rejection treatment was 132.6 µmol/L (95% confidence interval [95% CI], 78.7 to 186.5) in patients with isolated endarteritis, 96.4 µmol/L (95% CI, 48.6 to 143.2) in positive controls (P=0.32), and 18.6 µmol/L (95% CI, 1.8 to 35.4) in untreated negative controls (P
ISSN:1046-6673
1533-3450
DOI:10.1681/ASN.2014020157