Association between transplant glomerulopathy and graft outcomes following kidney transplantation: A meta-analysis

Abstract

Transplant glomerulopathy (TG), a morphological lesion associated with confluent mechanisms of endothelial injury of renal allografts, may provide a viable predictor of graft failure. This systematic literature review and meta-analysis were performed according to the PRISMA statement to examine evidence describing the association between TG and graft loss or failure and time to these events. The literature review was conducted using the Scopus, EBSCO, and Cochrane Library search engines. Hazard ratios, median survival times, and 95% confidence intervals (CIs) were estimated to evaluate graft survival in the total population and prespecified subgroups. Meta-regression analysis assessed heterogeneity. Twenty-one publications comprising 6,783 patients were eligible for data extraction and inclusion in the meta-analysis. Studies were highly heterogeneous (I 2 = 67.3%). The combined hazard ratio of graft loss or failure from random-effects meta-analysis was 3.11 (95% CI 2.44-3.96) in patients with TG compared with those without. Median graft survival in patients with TG was 3.25 (95% CI 0.94-11.21) years-15 years shorter than in those without TG (18.82 [95% CI 10.03-35.32] years). The effect of time from transplantation to biopsy on graft outcomes did not reach statistical significance (p = 0.116). TG was associated with a threefold increase in the risk of graft loss or failure and a 15-year loss in graft survival, indicating viability as a surrogate measure for both clinical practice and studies designed to prevent or reverse antibody-mediated rejection.

Impact of Glomerulitis on Long-term Outcomes After Kidney Transplantation

“…Transplant glomerulopathy is associated with chronic AMR and poor graft survival. 27,[29][30][31] The current study emphasizes the concept that glomerulitis may be associated with progression to chronic transplant glomerulopathy. We further analyzed a cohort of patients with subclinical isolated glomerulitis as there remains an ambiguity regarding the significance of glomerulitis and long-term outcomes.…”

Focal Segmental Glomerulosclerosis Superimposed on Transplant Glomerulopathy: Implications for Graft Survival

“…Renal graft survival in patients with TG was poor, manifested by a median graft survival time (3.25 years) less than that in patients without TG (18.82 years) [26]. Aubert et al [27] identified 5 archetypes of TG with distinct clinical, functional, immunological, and histological features, using an unsupervised learning method, and they found that the 5-year graft survival rates in different TG archetypes ranged from 88% to 22%, and the worst archetype was characterized by the highest proteinuria level, the highest mean cg score, and high chronic lesions.…”

Proposed Definitions of Antibody-Mediated Rejection for Use as a Clinical Trial Endpoint in Kidney Transplantation

“…Because of repeated revisions to Banff criteria (including gene transcripts and the requirement for EM, to detect PTCML and early TG lesions), the incidence of caAMR is under-reported. No studies fulfill all criteria for this diagnosis according to Banff 2017 or have a sufficient follow-up to use strictly defined Banff caAMR as an endpoint ( 58 ).…”