Kidney Allograft Vascular Disease Post-Transplant (KTX): Risk Factors and Implications
1Medicine, Mayo Clinic, Rochester, MN
2Pathology, Mayo Clinic, Rochester, MN.
Meeting: 2018 American Transplant Congress
Abstract number: 310
Keywords: Alloantibodies, Arteriosclerosis, Graft survival, Vascular disease
Session Information
Session Name: Concurrent Session: Kidney Complications: Diagnostic Considerations
Session Type: Concurrent Session
Date: Monday, June 4, 2018
Session Time: 4:30pm-6:00pm
Presentation Time: 4:42pm-4:54pm
Location: Room 6C
Background: Over time grafts develop arteriosclerosis (ART)and arteriolar hyalinosis (AH). Previous studies associated AH with calcineurin inhibitors (CNI), diabetes (DM), kidney age and hypertension. Other studies suggested that ART may relate to the presence of donor specific antibodies (DSA). We re-examine the development of new ART and AH post-KTX using protocol and clinical biopsies in a large KTX cohort.
Methods: Included 1721 adult, conventional single center KTX (1998-2014),51+14.4 yo, 61% males, 81.4% living donors, 25% DM. None had moderate-severe ART or AH at time 0 biopsy. T cell depletion used in 83% and CNI maintenance in 95%. End points were de novo moderate-severe ARTm/s or AHm/s in protocol or clinical biopsy and death-censored graft survival.
Results: The incidence of ARTm/s and AHm/s increased with time. At 1,5 and 8 years the cumulative incidence of ARTm/s was 11.6%, 43% and 66% and for AHm/s 4.4%, 35% and 69.7%. AHm/s was associated with reduced death-censored graft survival (time dependent, HR=3.89 (2.54-5.94), p<0.0001) independent of recipient/donor age, HLAmm, DSA, graft function and acute rejection. ARTm/s also independently related to reduced graft survival (time dependent HR=2.21 (1.47-3.33), p<0.0001). AHm/s developed more commonly in older donor grafts (HR=1.36 (1.32-1.41), p<0.0001 multivariate Cox), DSA class II at KTX (HR=1.81 (1.37-2.38), p<0.0001) and younger recipients (HR=0.88 (0.85-0.91), p=0.005). ARTm/s also developed more commonly in older donor grafts (HR=1.43 (1.39-1.48), p<0.0001) and DSAII (HR=1.84 (1.46-2.36)). In contrast neither ARTm/s or AHm/s related to DM, DSA class I, donor type, blood pressure or lipid levels at one year. DSAII at KTX related to earlier and more rapid development of ARTm/s (1 & 5 years: DSAII+, 23.2% and 64.6% vs DSAII-, 13.2% and 48.0%) and AHm/s (1 & 5 years: DSAII+, 5.7% and 51.7% vs DSAII-, 3.6% and 31.5%). When divided into quartiles by donor age (<34,34-44,45-53,>53) the incidence of ARTm/s at 5 years was 29%, 38%, 44% and 69%, and incidence of AHm/s was 13.9%, 30.5%, 33% and 62%.
Conclusions: ARTm/s and AHm/s develop progressively and relate to reduced graft survival. DSAII relate to earlier and more rapid ARTm/s and AHm/s. Increasing donor age related to lesion development suggesting that the graft is programmed to respond to injuries according to their age at transplant. Identifying grafts at risk for vascular lesions will allow testing for vascular protective maneuvers.
CITATION INFORMATION: El Ters M., Cornell L., Grande J., Cosio F. Kidney Allograft Vascular Disease Post-Transplant (KTX): Risk Factors and Implications Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Ters MEl, Cornell L, Grande J, Cosio F. Kidney Allograft Vascular Disease Post-Transplant (KTX): Risk Factors and Implications [abstract]. https://atcmeetingabstracts.com/abstract/kidney-allograft-vascular-disease-post-transplant-ktx-risk-factors-and-implications/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress