Abstract
We studied the relative association of clinical, histologic, and molecular variables with risk of kidney transplant failure after an indication biopsy, both in all kidneys and in kidneys with pure antibody-mediated rejection (ABMR). From a prospective study of 1679 biopsies with histologic and molecular testing, we selected one random biopsy per patient (N = 1120), including 321 with pure molecular ABMR. Diagnoses were associated with actuarial survival differences but not good predictions. Therefore we concentrated on clinical (estimated GFR [eGFR], proteinuria, time posttransplant, donor-specific antibody [DSA]) and molecular and histologic features reflecting injury (acute kidney injury [AKI] and atrophy-fibrosis [chronic kidney disease (CKD)] and rejection. For all biopsies, univariate analysis found that failure was strongly associated with low eGFR, AKI, CKD, and glomerular deterioration, but not with rejection activity. In molecular ABMR, the findings were similar: Molecular and histologic activity and DSA were not important compared with injury. Survival in DSA-negative and DSA-positive molecular ABMR was similar. Multivariate survival analysis confirmed the dominance of molecular AKI, CKD, and eGFR. Thus, at indication biopsy, the dominant predictors of failure, both in all kidneys and in ABMR, were related to molecular AKI and CKD and to eGFR, not rejection activity, presumably because rejection confers risk via injury.
Original language | English (US) |
---|---|
Pages (from-to) | 1391-1401 |
Number of pages | 11 |
Journal | American Journal of Transplantation |
Volume | 21 |
Issue number | 4 |
DOIs | |
State | Published - Apr 2021 |
Bibliographical note
Funding Information:This research has been principally supported by grants from Genome Canada, Canada Foundation for Innovation, the University of Alberta Hospital Foundation, the Alberta Ministry of Advanced Education and Technology, the Mendez National Institute of Transplantation Foundation, and Industrial Research Assistance Program. Partial support was also provided by funding from a licensing agreement with the One Lambda division of Thermo Fisher. Dr. Halloran held a Canada Research Chair in Transplant Immunology until 2008 and currently holds the Muttart Chair in Clinical Immunology.We thank Martina Mackova for her assistance in biopsy processing and interpretation. We thank our valued clinicians in the INTERCOMEX study group who partnered with us for this study by contributing biopsies and feedback (Michael Picton, Timm Heinbokel, Harold Yang, Seth Narins, Carmen Lefaucheur, Alexandre Loupy, Marek Myslak, Bertram Kasiske, Arthur Matas, and Arjang Djamali).
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
Keywords
- basic (laboratory) research / science
- biopsy
- graft survival
- kidney failure / injury
- kidney transplantation / nephrology
- microarray / gene array
- rejection: antibody-mediated (ABMR)