Histopathologic Features that Predict Transplant Glomerulopathy Progression in a Chinese Cohort

Li, Xue; Chen, Jinsong; Dai, Cheng; Wang, Wei; Xie, Ke; Zhang, Mingchao; Xu, Feng; Wen, Jie; Tang, Zheng

doi:10.1159/000500043

Cited by 8 publications

(9 citation statements)

References 30 publications

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“…Contrary to the results of previous studies, C4d deposition in PTC was identified as a risk factor for proteinuria in TG patients in our study (13,25). Peritubular capillary C4d usually represents active antibody-mediated rejection, all C4d positive patients showed evidence of DSA before the biopsy in our study (33).…”

Section: Discussioncontrasting

confidence: 99%

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Clinicopathologic Features and Risk Factors of Proteinuria in Transplant Glomerulopathy

et al. 2021

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Background: Transplant glomerulopathy (TG) is one of the main causes of post-transplant proteinuria (PU). The features and possible risk factors for proteinuria in TG patients are uncertain.Methods: We investigated all patients who had biopsy-proven TG from 2000 to 2018 in our center. The clinical and histological data were compared between two groups with or without PU (cut-off = 0.3 g/day). Spearman correlation analysis was used to evaluate the relationship between PU and pathological changes. The risk factors for PU in TG patients were determined by multivariable logistic regression analysis.Results: One hundred and twenty-five (75.76%) of all enrolled 165 TG patients had proteinuria ≥0.3 g/day at the time of biopsy. TG patients' PU level was significantly correlated with Banff lesion score cg (ρ = 0.247, P = 0.003), and mm (ρ = 0.257, P = 0.012). Systolic blood pressure ≥140 mmHg (OR 2.72, 95% CI 1.04–7.10, P = 0.041), diastolic blood pressure ≥90 mmHg (OR 4.84, 95% CI 1.39–16.82, P = 0.013), peak PRA ≥5% (OR 6.47, 95% CI 1.67–25.01, P = 0.007), positive C4d staining (OR 4.55, 95% CI 1.29–16.11, 0.019), tacrolimus-based regimen (OR 3.5, 95% CI 1.28–9.54, P = 0.014), and calcium channel blocker usage (OR 4.38, 95% CI 1.59–12.09, P = 0.004) were independent risk factors for PU.Conclusions: Proteinuria is common in TG patients. systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, peak PRA ≥5%, positive C4d staining, tacrolimus-based regimen, and calcium channel blocker usage are associated with proteinuria in TG patients.

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Section: Discussioncontrasting

confidence: 99%

“…Consistent with previous studies, the severity of proteinuria was significantly correlated with Banff lesion score cg and mm though both of them were not significant in univariable and multivariable logistic regression analysis (13,25,26). This might due to the lower cut-off value for the diagnosis of proteinuria in this study.…”

Section: Discussionsupporting

confidence: 84%

Clinicopathologic Features and Risk Factors of Proteinuria in Transplant Glomerulopathy

et al. 2021

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“…Our study provided additional insight into the prognostic value of proteinuria at the time of diagnostic biopsy of TG as well as dynamic proteinuria changes of during follow‐up. The existing studies regarding the influence of proteinuria on the survival of TG patients showed conflicting results, which might be due to the small sample size, the different criteria on patient inclusion and different patient cohorts [7,16–20]. Compared with previous studies, our study excluded patients with secondary TG, such as recurrent/ de novo glomerulonephritis, TMA, and hepatitis C virus‐associated MPGN, which might control the effect of these confounders to improve the reliability of the results [21].…”

Section: Discussionmentioning

confidence: 99%

The relationship between proteinuria and allograft survival in patients with transplant glomerulopathy: a retrospective single‐center cohort study

et al. 2021

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Summary Proteinuria and transplant glomerulopathy (TG) are common in kidney transplantation. To date, there is limited knowledge regarding proteinuria in different types of TG and its relationship to allograft survival. A retrospective cohort analysis of TG patients from indication biopsies was performed to investigate the relationship of proteinuria, histology, and graft survival. One hundred and seven (57.5%) out of 186 TG patients lost their grafts with a median survival of 14 [95% confidence interval (CI) 10–22] months after diagnosis. Proteinuria ≥1 g/24 h at the time of biopsy was detected in 87 patients (46.8%) and the median of proteinuria was 0.89 (range 0.05–6.90) g/24 h. TG patients with proteinuria ≥1 g/24 h had worse 5‐year graft survival (29.9% vs. 53.5%, P = 0.001) compared with proteinuria <1 g/24 h. Proteinuria was associated with graft loss in univariable Cox regression [hazard ratio (HR) 1.25, 95% CI, 1.11–1.41, P < 0.001], and in multivariable analysis (adjusted HR 1.26, 95% CI 1.11–1.42, P < 0.001) independent of other risk factors including creatinine at biopsy, positive C4d, history of rejection, and Banff lesion score mesangial matrix expansion. In this cohort of TG patients, proteinuria at indication biopsy is common and associated with a higher proportion of graft loss.

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“…However, within the TG diagnosis, several individual parameters have been associated with graft loss in studies. For instance, time of onset of TG (early vs late), TG severity (by Banff) and amount of proteinuria have all been associated with poor long‐term allograft survival 6,18,50 . Further, differential gene expression of complement cascade, interleukins, granulysin and ENDATs were associated with allograft loss, suggesting that gene expression profiles might help in predicting allograft loss within this syndrome 7 …”

Section: Prognosismentioning

confidence: 99%

Chronic transplant glomerulopathy: New insights into pathogenesis

Gokhale

Chancay

Shapiro

et al. 2021

Clinical Transplantation

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There have been recent significant advances in short‐term outcomes in renal transplantation, however, long‐term allograft survival remains a challenge. With reported incidences as high of 74.5% of chronic graft loss in patients with biopsies showing transplant glomerulopathy (TG), this syndrome represents an important factor for chronic allograft complications. In this review we show an overview of the novel mechanistic insights into pathogenesis of TG, as well as a brief description of the pathology, diagnosis and newer prognostic indices within TG diagnosis. These data raise intriguing roles for cell‐mediated immunity and podocyte stress in TG as well as reinforce previous associations of TG with ABMR. We also delve into management strategies for TG and report the paucity of existing clinical trial data for this prevalent condition in renal transplants.

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Histopathologic Features that Predict Transplant Glomerulopathy Progression in a Chinese Cohort

Cited by 8 publications

References 30 publications

Clinicopathologic Features and Risk Factors of Proteinuria in Transplant Glomerulopathy

Clinicopathologic Features and Risk Factors of Proteinuria in Transplant Glomerulopathy

The relationship between proteinuria and allograft survival in patients with transplant glomerulopathy: a retrospective single‐center cohort study

Chronic transplant glomerulopathy: New insights into pathogenesis

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