Impact of Glomerulitis on Long-term Outcomes After Kidney Transplantation

Abstract

Background. The Banff classification scheme provides a framework for interpreting transplant kidney biopsies and has undergone various updates in the past 2 decades especially related to antibody-mediated rejection. The clinical significance of early glomerulitis seen within 4 mo on protocol biopsies has received limited attention. We hypothesized that early glomerulitis seen on protocol biopsies will lead to significant adverse outcomes as assessed by histopathology and allograft outcome. Methods. A single-center retrospective study of a cohort of patients who underwent protocol biopsies within 4 mo after transplantation with timely follow-up protocol biopsies were assessed. Patients with recurrent glomerulonephritis were excluded. Results. We calculated glomerulitis (g) scores for 2212 biopsy specimens and identified 186 patients with glomerulitis (g > 0) and 2026 patients without glomerulitis (g = 0). The progression to chronic transplant glomerulopathy at 1 and 2 y was higher in patients with g > 0 as compared with g = 0 (year 1, 10.7% versus 2.3% [P < 0.001]‚ respectively; year 2, 17.2% versus 4.3% [P < 0.001], respectively) with no difference in other chronic lesions. The death-censored graft failure rate was higher in patients with g > 0 as compared with g = 0 (hazard ratio, 1.68 [95% CI, 1.07-2.65]; P = 0.02). We did not find any difference in outcomes in glomerulitis group based on donor-specific antibody. Conclusion. Our findings suggest that early glomerulitis (seen within 4 mo after transplantation) may lead to clinically significant long-term changes and thus could be a target for early intervention therapies.

Genetic polymorphisms of Leukocyte Immunoglobulin-Like Receptor B3 (LILRB3) gene in African American kidney transplant recipients are associated with post-transplant graft failure

“…The LILRB3 -4SNPs was associated with the high incidence of glomerulitis (Banff g>1) in the GoCAR (p=0.044, Table S16 ) and BioMe (p=0.004, Table S17 ) cohorts. Glomerulitis is one key factor for chronic transplant glomerulopathy and renal failure 30 and also associated with graft loss in GoCAR cohort (g at 3 m, p=0.04; g at12 m, p=0.04; g at 24m, p = 0.01) ( Table S18) . Interestingly, In BioMe cohort, LILRB3 -4SNPs was also linked to the development of sepsis in kidney transplant patients (p=0.010) ( Table S19 ).…”