TY - JOUR
T1 - Histopathologic clusters differentiate subgroups within the nonspecific diagnoses of CAN or CR
T2 - Preliminary data from the DeKAF study
AU - Matas, A. J.
AU - Leduc, R.
AU - Rush, D.
AU - Cecka, J. M.
AU - Connett, J.
AU - Fieberg, A.
AU - Halloran, P.
AU - Hunsicker, L.
AU - Cosio, F.
AU - Grande, J.
AU - Mannon, R.
AU - Gourishankar, S.
AU - Gaston, R.
AU - Kasiske, B.
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/2
Y1 - 2010/2
N2 - The nonspecific diagnoses 'chronic rejection' 'CAN', or 'IF/TA' suggest neither identifiable pathophysiologic mechanisms nor possible treatments. As a first step to developing a more useful taxonomy for causes of new-onset late kidney allograft dysfunction, we used cluster analysis of individual Banff score components to define subgroups. In this multicenter study, eligibility included being transplanted prior to October 1, 2005, having a 'baseline' serum creatinine ≤2.0 mg/dL before January 1, 2006, and subsequently developing deterioration of graft function leading to a biopsy. Mean time from transplant to biopsy was 7.5 ± 6.1 years. Of the 265 biopsies (all with blinded central pathology interpretation), 240 grouped into six large (n > 13) clusters. There were no major differences between clusters in recipient demographics. The actuarial postbiopsy graft survival varied by cluster (p = 0.002). CAN and CNI toxicity were common diagnoses in each cluster (and did not differentiate clusters). Similarly, C4d and presence of donor specific antibody were frequently observed across clusters. We conclude that for recipients with new-onset late graft dysfunction, cluster analysis of Banff scores distinguishes meaningful subgroups with differing outcomes.
AB - The nonspecific diagnoses 'chronic rejection' 'CAN', or 'IF/TA' suggest neither identifiable pathophysiologic mechanisms nor possible treatments. As a first step to developing a more useful taxonomy for causes of new-onset late kidney allograft dysfunction, we used cluster analysis of individual Banff score components to define subgroups. In this multicenter study, eligibility included being transplanted prior to October 1, 2005, having a 'baseline' serum creatinine ≤2.0 mg/dL before January 1, 2006, and subsequently developing deterioration of graft function leading to a biopsy. Mean time from transplant to biopsy was 7.5 ± 6.1 years. Of the 265 biopsies (all with blinded central pathology interpretation), 240 grouped into six large (n > 13) clusters. There were no major differences between clusters in recipient demographics. The actuarial postbiopsy graft survival varied by cluster (p = 0.002). CAN and CNI toxicity were common diagnoses in each cluster (and did not differentiate clusters). Similarly, C4d and presence of donor specific antibody were frequently observed across clusters. We conclude that for recipients with new-onset late graft dysfunction, cluster analysis of Banff scores distinguishes meaningful subgroups with differing outcomes.
KW - Allograft function
KW - Kidney transplantation
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U2 - 10.1111/j.1600-6143.2009.02943.x
DO - 10.1111/j.1600-6143.2009.02943.x
M3 - Article
C2 - 20041864
AN - SCOPUS:75149147570
SN - 1600-6135
VL - 10
SP - 315
EP - 323
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 2
ER -