Improved Graft Survival after Renal Transplantation in the United States, 1988 to 1996

The natural history and pathogenesis of the pathologic lesions that define rejection of kidney transplants have not been well characterized. We studied the evolution of the pathology of rejection in mouse kidney allografts, using four strain combinations across full major histocompatibility complex (MHC) plus nonMHC disparities, to permit more general conclusions. Interstitial infiltrate, MHC induction, and venulitis appeared by day 5, peaked at day 7-10, then stabilized or regressed by day 21. In contrast, tubulitis, arteritis, and glomerulitis were absent or mild at days 5 and 7, but progressed through day 21, indicating separate regulation and homeostatic control of these lesions. Edema, hemorrhage, and necrosis also increased through day 21. All lesions were T-dependent, failing to develop in T-cell-deficient hosts. Allografts into immunoglobulindeficient hosts manifested typical infiltration, MHC induction, and tubulitis at days 7 and 21, indicating that these lesions are alloantibody-independent. However at day 21 kidneys rejecting in immunoglobulindeficient hosts showed decreased edema, arteritis, venulitis, and necrosis.Thus the three groups of lesions are: T-cell-mediated interstitial infiltration, MHC induction, and venulitis, which develops rapidly then stabilizes; slower but progressive T-cell-mediated tubulitis and arteritis; and late antibody-mediated endothelial injury, which contributes to late edema, arteritis, and venulitis.

“…Number of mice used in the experiments is shown in parentheses. 1 Significantly different from control, p < 0.05 (Mann-Whitney). N/A = not available.…”

Section: Renal Transplantationmentioning

confidence: 89%

“…For clarity, the number of mice is entered for the interstitial infiltrate only. 1 Significant difference compared with day 5 and 2 day 7. p < 0.05 (Mann-Whitney). N/A = not available.…”

Section: Antibodiesmentioning

confidence: 94%

Heterogeneity in the Evolution and Mechanisms of the Lesions of Kidney Allograft Rejection in Mice

Jabs

Sedlmeyer

Ramassar

et al. 2003

“…In a recent review of US data, there was a steady improvement in both short-and long-term renal graft survival from 1988 to 1996 (63). Other series have reported graft outcomes for SLE renal recipients to be similar to outcomes for recipients with other etiologies (8,27,28,(64)(65)(66).…”

Section: Graft Lossmentioning

confidence: 98%

Pregnancy Outcomes in Female Renal Recipients: A Comparison of Systemic Lupus Erythematosus With Other Diagnoses

McGrory¹,

McCloskey²,

DeHoratius

et al. 2003

This study compares pregnancy outcomes in systemic lupus erythematosus (SLE) patients post renal transplant with recipients with other primary diagnoses, utilizing data from the National Transplantation Pregnancy Registry, Philadelphia, PA. Recipients were referred from transplant centers nationwide. A retrospective analysis was performed using data from questionnaires, hospital records and telephone interviews. Outcomes of pregnancies post renal transplant secondary to lupus nephritis (SLE: n Ω 38; 60 pregnancies) were compared with the pregnancy outcomes of renal recipients with other diagnoses (non-SLE: n Ω 247; 374 pregnancies). Drug-treated hypertension during pregnancy was less common in the SLE group than in the non-SLE group (45.0% vs. 62.5%, p Ω 0.015). There were fewer cesarean sections in the SLE group (30.2 vs. 53.2%, p Ω 0.008). There was no primary or gestational diabetes in the SLE group. There were no other statistical differences in maternal conditions or pregnancy outcomes between the SLE and non-SLE groups, or in the incidence of post pregnancy graft loss. Female recipients transplanted for renal failure secondary to lupus nephritis can successfully maintain pregnancy. Outcomes are comparable to renal recipients with other diagnoses. Newborns in both groups were often premature and had low birthweight. Overall childhood health was reported to be good; there were no apparent predominant structural malformations among the children.

“…In spite of previous developments, in the past 2 decades, there was only little improvement in long‐term graft and patient survival after renal transplantation 5. Approximately 50% of all renal allografts from deceased donors are lost in a period of 10‐12 years after transplantation 6. As a result of this stagnation, there is a growing interest in other factors that may influence graft and patient survival after renal transplantation, such as diet and other lifestyle factors.…”

Section: Introductionmentioning

confidence: 99%

Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients

Osté

Gomes-Neto

Corpeleijn

et al. 2018

Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as an important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective cohort study of adult RTR. Dietary data were collected using a validated 177‐item food frequency questionnaire and an overall DASH‐score was obtained. We included 632 stable RTR (mean ± standard deviation age 53.0 ± 12.7 years, 57% men). Mean DASH score was 23.8 ± 4.7. During median follow‐up of 5.3 (interquartile range, 4.1‐6.0) years, 119 (18.8%) RTR had renal function decline, defined as a combined endpoint of doubling of serum creatinine and death‐censored graft failure, and 128 (20.3%) died. In Cox‐regression analyses, RTR in the highest tertile of the DASH score had lower risk of both renal function decline (hazard ratio [HR] = 0.57; 95% confidence interval [CI], 0.33‐0.96, P = .03) and all‐cause mortality (HR = 0.52; 95%CI, 0.32‐0.83, P = .006) compared to the lowest tertile, independent of potential confounders. Adherence to a DASH‐style diet is associated with lower risk of both renal function decline and all‐cause mortality. These results suggest that a healthful diet might benefit long‐term outcome in RTR.