scholarly journals MORPHOLOGICAL STRUCTURE OF LATE RENAL GRAFT DYSFUNCTION AND ITS EFFECT FOR LONG-TERM RESULTS

2018 ◽  
Vol 20 (1) ◽  
pp. 45-54 ◽  
Author(s):  
E. S. Stolyarevich ◽  
T. R. Zhilinskaya ◽  
L. Yu. Artyukhina ◽  
I. G. Kim ◽  
V. A. Zaydenov ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Graft Survival ◽  
Chronic Rejection ◽  
De Novo ◽  
Long Term Results ◽  
Functional Disorders ◽  
Graft Dysfunction ◽  
Tubular Atrophy ◽  
Allograft Dysfunction ◽  
Over Time

Aim:to analyze the frequency of different histological diagnoses and it simpact on graft survival in a cohort of patients with renal allograft dysfunction, and to determine pathology features, infl uencing prognosis.Materials and methods.The data obtained from 1470 biopsies, performed by indication at different time after kidney transplantation (48.8 ± 46.1 months) were analyzed retrospectively according to the Banff 2013 classifi cation. Results.The majority of graft dysfunction episodes were attributed to fi ve causes: acute (26,8%) and chronic (12,4%) rejection; chronic nephrotoxicity of СNI (19,3%), interstitial fi brosis/tubular atrophy (15,8%) and recurrent or de novo glomerulonephritis (10,6%). T-cell-mediated acute rejection and functional disorders were the most often cause of dysfunction during the fi rst year after transplantation (40,5% and 21% respectively) but decreased over time. On the other hand, the frequency of chronic rejection, interstitial fi brosis/tubular atrophy with or without СNI nephrotoxicity and recurrent or de novo glomerulonephritis increased from 13%, 26% and 5,5% at the fi rst year to 26,4%, 35,3% and 22,8% respectively at 8 year after transplantation. Chronic rejection represented a major risk for graft loss – 8-year graft survival did not exceed 5%. The prognosis of acute rejection as well asde novoor recurrent glomerular pathologies was more favorable (38% and 42% respectively). In cases of interstitial fi brosis/tubular atrophy with or without СNI nephrotoxicity 8-year graft survival was slightly lower than in the functional disorders (62% and 76%). In acute rejection prognosis for C4d-positive forms was worse compared to C4d-negative, while in chronic rejection there was no difference between C4d-positive and C4d-negative forms. The features of СNI nephrotoxicity did not infl uence the prognosis of non-specifi c interstitial fi brosis and tubular atrophy.Conclusion.Transplant pathology in patients with allograft dysfunction is heterogeneous and changes over time. Acute and chronic rejection; interstitial fi brosis/tubular atrophy with or without СNI nephrotoxicity and recurrent/de novoglomerular pathology are the most often causes of graft dysfunction, but only rejection (mostly chronic) and glomerular pathology are associated with unfavorable prognosis.

Chronic allograft dysfunction

2015 ◽  
Author(s):  
Lorna K. Henderson ◽  
Brian J. Nankivell ◽  
Jeremy R. Chapman
Keyword(s):  
Renal Allograft ◽  
Graft Loss ◽  
Graft Dysfunction ◽  
Short Term ◽  
Tubular Atrophy ◽  
Term Survival ◽  
Chronic Allograft Dysfunction ◽  
Allograft Dysfunction ◽  
Immune Mediated

Despite improvements in short-term renal allograft survival, long-term survival has not appreciably changed. Excepting death with a functioning graft, most late graft loss results from chronic allograft dysfunction. Immune and non-immune-mediated injuries contribute to graft dysfunction over time, ultimately leading to a non-specific and irreversible histological end-point of fibrosis, tubular atrophy, and glomerulosclerosis. Screening and early identification of pathology is crucial to allow timely intervention in order to prevent permanent nephron damage and graft loss. This chapter outlines assessment of renal dysfunction following transplantation, defines the causes of chronic allograft failure, and their pathophysiology, and evaluates current therapeutic strategies used to improve or stabilize chronic allograft dysfunction.

scholarly journals Predictors of Mid-Term Glomerular Filtration Rate after Deceased Donor Renal Transplantation: Kidney Donor Profile Index as a Predictor of Mid-Term GFR

2021 ◽  
Vol 05 (03) ◽  
pp. 1-1
Author(s):  
Oya M. Andacoglu ◽  
◽  
Jack Liu ◽  
Abigail L. Brooks ◽  
Amit Blumfield ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Renal Transplantation ◽  
Acute Rejection ◽  
Glomerular Filtration ◽  
Chronic Rejection ◽  
Filtration Rate ◽  
De Novo ◽  
Deceased Donor ◽  
Donor Age ◽  
Ischemic Time

Glomerular filtration rate (GFR) is an excellent indicator of renal function; however, it is rarely evaluated as an endpoint. We investigated donor and recipient factors for associations that might be predictive of mid-term GFR after renal transplantation. We performed a retrospective review of 828 deceased donor renal transplantations performed at Montefiore Medical Center between the years 2009-2015. Donor characteristics included KDPI, [low (<20%), medium (20-80%), high (>80%)], age, graft types [extended criteria (ECD), cardiac death (DCD), standard criteria (SCD)], CDC high risk, HCV status and cold ischemic time (CIT). Recipient factors included age at transplant, induction agent, BK status, CMV status, acute and chronic rejection, cPRA and DSA status. Primary outcome is 3-year GFR calculated via the MDRD equation. In univariate analysis, donor age, KDPI, ECD, and chronic rejection were significantly associated with changes in 3-year GFR (p<0.001). In the multivariable regression analysis, donor age, KDPI, and chronic rejection remained associated with changes in 3-year GFR (p<0.001). Acute rejection, DCD, HCV status, CIT, BK and CMV viremia, PRA, pretransplant or de novo DSA were not associated with changes in 3-year GFR (p>0.05). We conclude that donor age, KDPI, and chronic rejection are independently associated with 3-year GFR while acute rejection, DCD, HCV status, CIT, BK and CMV viremia, PRA, existing or de novo DSA were not. Based on these findings, current scoring systems may need refinement to address the prognosis of mid-term GFR.

scholarly journals Mycophenolate Mofetil Does Not Modify the Incidence of Cytomegalovirus (CMV) Disease after Kidney Transplantation but Prevents CMV-Induced Chronic Graft Dysfunction

2001 ◽  
Vol 12 (8) ◽  
pp. 1758-1763
Author(s):  
MAGALI GIRAL ◽  
JEAN MICHEL NGUYEN ◽  
PASCAL DAGUIN ◽  
MARYVONNE HOURMANT ◽  
DIEGO CANTAROVICH ◽  
...  
Keyword(s):  
Mycophenolate Mofetil ◽  
Acute Rejection ◽  
Graft Survival ◽  
Treated Group ◽  
Graft Dysfunction ◽  
Cmv Infection ◽  
Virus Activity ◽  
Chronic Graft Dysfunction ◽  
Herpès Virus ◽  
Cmv Disease

Abstract. Ganciclovir, which is used to treat cytomegalovirus (CMV) infection, has been shown in rodent models to abolish CMV-mediated chronic cellular damage and endothelial cell proliferation; when associated with mycophenolate mofetil (MMF), it has been shown to increase its anti—herpes virus activity. This study tested the hypothesis that kidney graft recipients who received antirejection prophylaxis with MMF and who were treated with ganciclovir for a declared CMV disease could be protected from chronic graft dysfunction. Investigated was the impact of ganciclovir-treated CMV diseases in consecutive first kidney recipients according to their immunosuppressive therapy. The azathioprine (Aza)-treated group (Aza group) included 319 patients. The MMF-treated group (MMF group) included 126 patients. CMV disease was clinically defined and confirmed by virological proof of CMV infection and was treated for at least 14 d with ganciclovir. Despite having the same incidence (21.6% in the Aza group versus 24.6% in the MMF group) and severity, CMV disease was significantly associated with graft loss independent of acute rejection episodes or other factors when tested in a Cox proportional model in the Aza group only (P < 10-4). It was shown for the first time that patients whose CMV disease is treated with ganciclovir while they are on MMF therapy are protected from the long-term deleterious consequences of CMV disease on graft survival, independent of acute rejection. It is suggested that the enhanced anti—herpes virus activity of ganciclovir by MMF could contribute to this reported effect, which may represent a significant contribution of MMF efficacy to graft survival.

Dual Transplant of Marginal Kidneys

Swiss Surgery ◽  
2003 ◽  
Vol 9 (5) ◽  
pp. 213-215
Author(s):  
Matter ◽  
Venetz ◽  
Aubert ◽  
Gachet ◽  
Burnier ◽  
...  
Keyword(s):  
Case Report ◽  
Acute Rejection ◽  
Glomerular Filtration ◽  
Graft Survival ◽  
Long Term Results ◽  
Recent Analysis ◽  
Donor Kidney ◽  
Transplant Outcomes

Introduction: Double transplantation is one possible answer to the shortage of donor organs. While each donor kidney would be unsuitable when considered as a single allograft, use of both kidneys should provide sufficient nephron mass for effective glomerular filtration. Case report: This is the first Swiss report of a dual adult transplant of marginal kidneys in a 46-year-old man, who was transplanted for the fourth time. Follow-up at 6 months is excellent without acute rejection. Conclusion: Recent analysis of dual marginal versus single ideal transplant outcomes, found a comparable 1-yr graft survival in both of the procedures. Long term results are still lacking and guidelines to decide between single, double or no transplantation are emerging.

scholarly journals SPECTRUM OF RENAL ALLOGRAFT BIOPSY FINDINGS IN RENAL TRANSPLANT PATIENTS AT A TERTIARY CARE CENTER IN RAWALPINDI, PAKISTAN

2021 ◽  
Vol 71 (3) ◽  
pp. 942-46
Author(s):  
Khurram Mansoor ◽  
Muhammad Osama ◽  
Muhammad Ishaque ◽  
Sohail Sabir ◽  
Hafeez Ud Din ◽  
...  
Keyword(s):  
Renal Allograft ◽  
Interstitial Fibrosis ◽  
Care Center ◽  
Tertiary Care ◽  
Histopathological Diagnosis ◽  
Care Hospital ◽  
Graft Dysfunction ◽  
Tubular Atrophy ◽  
Common Cause ◽  
Allograft Dysfunction

Objective: To evaluate outcome of diagnostic kidney biopsy in patients with renal allograft dysfunction at a tertiary care hospital. Study Design: Retrospective observational study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2014 to Jan 2020. Methodology: A consolidate registry review was carried to formulate this study. The registry data exists at our center containing information about the graft dysfunction (manifesting as proteinuria, deranged urea and creatinine or urine sediment abnormalities) and other major indications which warrant probing with biopsy. The histopathological diagnosis of these biopsies is confirmed from the nephro-pathology registry before finalization of diagnosis. Results: A total of 94 diagnostic kidney biopsies were performed in patients with graft dysfunction. Out of 94 biopsies, 80 (85.1%) patients were male while 14 (14.9%) were female patients. The most frequent single cause for graft dysfunction was Cell Mediated Rejection (n 12, 24.5%) followed by Interstitial Fibrosis and Tubular Atrophy/Acute Tubular Injury. The most common cause among the glomerulonephritis was Membranoproliferative Glomerulonephritis (n 3, 6.1%) followed by others. The most common cause for mixed pathology remainedcell mediated rejection with Interstitial fibrosis and tubular atrophy (n 8, 17.8%). Conclusion: Cell mediated rejection is thecommonest pathology responsible for renal allograft dysfunction both as a single lesion as well as part of mixed pathology.

MO970GRAFT OUTCOME AFTER ACUTE REJECTION: A CASE CONTROL STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Safa Fattoum ◽  
Mohamed Mongi Bacha ◽  
Tasnim Mosbahhi ◽  
Nesrine Braiek ◽  
Ezzedine Abderrahim ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Graft Survival ◽  
Functional Recovery ◽  
Graft Function ◽  
Early Period ◽  
Transplant Patients ◽  
Graft Outcome ◽  
Group A ◽  
Group B ◽  
Over Time

Abstract Background and Aims Although Acute rejection (AR) is a complication associated with the early period after kidney transplantation (KT), its complications are mostly seen after a long term. The aim of this study was to evaluate graft outcome after AR. Method It was a longitudinal, retrospective, analytical study including kidney transplant patients followed up in our department between 1986 and 2019. Our population was divided in 2 groups: group A (129 KT complicated by at least one episode of AR) and group B (491 KT not complicated by AR). Results AR was responsible of immediate loss of 2 grafts. Chronic graft dyfonction was more frequent in group A (44,1% versus 17,4%, p&lt;0,0001). Creatininemia levels were significantly higher at 3, 6 months, 1 year and 2 years (respectively p =0,0113 ; &lt;0,0001 ; 0,0003 and 0,0172) after KT. The percentage of patients having creatinine levels &gt; 130 µmol/l was higher in group A at 3, 6 months, 1 year, 2 years, 3 years and 5 years (respectively p =0,0186 ; 0,001 ; &lt;0,0001 ; 0,0115 ; 0,0073 and 0,0255). Graft survival was better in group B (p&lt;0,0001). In group A, AR recurrence was responsible of a worser survival (p&lt;0,0001). Over time, graft survival improved in the 2 groups. Complete functional recovery survival was similar to graft with no rejection but with impared graft function. The worst graft survival was noted if the functional recovery was absent. Conclusion Even if graft outcome after AR has improved over time, its deleterious effect is still inevitable. So AR must be prevented in order to enhance graft outcome.

scholarly journals Long-Term Results of TPMT Activity Monitoring in Azathioprine-Treated Renal Allograft Recipients

2001 ◽  
Vol 12 (1) ◽  
pp. 170-176
Author(s):  
ERIC THERVET ◽  
DANY ANGLICHEAU ◽  
NATHALIE TOLEDANO ◽  
ANNE-MARIE HOULLIER ◽  
LAURE-HÉLÈNE NOEL ◽  
...  
Keyword(s):  
Acute Rejection ◽  
Graft Survival ◽  
Renal Allograft ◽  
Long Term Results ◽  
Tpmt Activity ◽  
Acute Rejection Episode ◽  
Blood Levels ◽  
Graft Outcome ◽  
Activity Induction

Abstract. Thiopurine methyltransferase (TPMT) is implicated in the metabolism of azathioprine. The consequences of differential TPMT activity induction by azathioprine on the long-term results after renal transplantation were investigated. The erythrocyte TPMT activity in 82 patients on days 0, 7, and 30 was prospectively evaluated. Because various patterns of TPMT activity variation were noted, the population was subsequently divided between inductors (n = 47) and noninductors (n = 35). Data regarding patient and graft survival and acute rejection episodes were collected. Renal allograft assessment was performed at 3 mo and 2 yr to evaluate the renal function and the histologic lesions on routine biopsies. Data regarding azathioprine-related toxicity also were collected. In a subgroup of patients (n = 19), azathioprine blood levels were determined at day 7 and day 30. The graft survival censoring death was statistically improved in TPMT inductor patients when compared with non-TPMT inductors (P < 0.05). Among TPMT inductors, an acute rejection episode was observed in 34% of the patients versus 69% among non-TPMT inductors (P = 0.002). At 3 mo, serum creatinine was significantly lower among TPMT inductors when compared with non-TPMT inductors (123.1 ± 7.6 and 161.4 ± 13.9 μmol/L, respectively; P = 0.01). On routine allograft biopsies at 2 yr (n = 61), grade 2 or 3 chronic lesions were present in 19% versus 25%, respectively (P = NS). At days 7 and 30, the azathioprine blood levels were higher among patients who experienced acute rejection (P < 0.02). TPMT activity induction was observed in 57% of renal transplant recipients who received azathioprine. This induction was associated with better graft outcome. The appropriate conversion from azathioprine, which is a pro-drug, into 6-mercaptopurine could explain both better graft outcome and TPMT induction. Assessing the ability of azathioprine metabolism at an individualized level before transplantation may allow a more accurate choice among the different immunosuppressive treatments.

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