Inflammation lesions in kidney transplant biopsies: Association with survival is due to the underlying diseases

J. Sellarés, D. G. De Freitas, M. Mengel, B. Sis, L. G. Hidalgo, A. J. Matas, B. Kaplan, Philip F. Halloran

Research output: Contribution to journalArticlepeer-review

59 Scopus citations

Abstract

Assessment of kidney transplant biopsies relies on nonspecific inflammatory lesions: Interstitial infiltrates (i), tubulitis (t) and intimal arteritis (v). We studied the relationship between inflammation and prognosis in biopsies for clinical indications from 314 patients (median follow-up 25 months). We used a modified Banff classification, separately assessing inflammation (i-) in nonscarred (i-Banff), scarred (i-IFTA) and whole cortex (i-total), plus tubulitis and intimal arteritis. In early biopsies (<1 year), i- and t-lesions had no association with graft survival. In late (>1 year) biopsies, all i-scores correlated with progression to failure, due to the association of these infiltrates with progressive diseases: antibody-mediated rejection (ABMR) and glomerulonephritis. Tubulitis in non-scarred areas had no impact on survival. Severe tubulitis including scarred areas (tis3) was associated with worse survival, but reflected polyoma virus nephropathy or ABMR, not T-cell-mediated rejection. Intimal arteritis (v-lesions) had no association with allograft loss in early or late biopsies. In multivariate analysis, outcome was better predicted by the presence of progressive disease than by inflammation. Thus inflammation in late kidney transplants has no inherent prognostic impact, but predicts reduced survival because inflammation indicates actively progressing diseases. The most important predictor of outcome is the diagnosis of a progressive disease.

Original languageEnglish (US)
Pages (from-to)489-499
Number of pages11
JournalAmerican Journal of Transplantation
Volume11
Issue number3
DOIs
StatePublished - Mar 2011

Keywords

  • Banff classification
  • Donor specific antibody
  • Pathology
  • Renal allograft rejection
  • Transplantation

Fingerprint Dive into the research topics of 'Inflammation lesions in kidney transplant biopsies: Association with survival is due to the underlying diseases'. Together they form a unique fingerprint.

Cite this