Factor Analysis (FA) of Renal Transplant Biopsy (KTxBx) Data Enables Objective Assessment of Risk for Subsequent Death Censored Graft Failure (DCGF)

L. Hunsicker,¹ J. Grande,² J. Cecka,³ A. Matas,⁴ The DeKaf Consortium.

¹Int. Med., UIowa, Iowa City, IA
²Pathology, Mayo Clinic, Rochester, MN
³Immunogenetics, UCLA, Los Angeles, CA
⁴Surgery, U Minnesota, Minneapolis, MN.

Meeting: 2018 American Transplant Congress

Abstract number: 314

Keywords: Biopsy, Kidney transplantation, Multicenter studies, Risk factors

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: 5:30pm-5:42pm

Location: Room 6C

We examined the impact of five axes of injury identified by FA in the KTxBx on the hazard for subsequent DCGF in two DeKAF cohorts.

Methods: The Cross-Sectional Cohort (CSC) included patients >6 months after transplant (Tx) with stable serum creatinine before 2006 undergoing KTxBx for later rise in Scr or new proteinuria. The Prospective Cohort (PC) entered new Tx; those biopsied for similar renal injury >3 months post-Tx are included in this report. FA was performed as described in Abstract 250910 using 17 Banff, C4d, and DSA variables. Injury scores for each identified Factor were computed for each biopsy. Complete data were available from 380 CSC and 191 PC index biopsies. Injury scores were scaled to standard deviations of 1 to permit comparison of effect sizes. Multivariate survival (Cox) analysis was used to evaluate the impacts of the identified Factors and CKDEpi eGFR on the risk of subsequent DCGF.

Results: FA identified the same five axes of injury (Factors) in biopsies of both cohorts: antibody mediated rejection (AMR), microvascular inflammation (MVI), acute cellular rejection (ACR), inflammation/tubulitis in areas of atrophy (IATR), and interstitial fibrosis/tubular atrophy (IFTA). The table shows coefficients and hazard (Rel.Risk) from multivariate Cox analysis of the impact of 5 factors and eGFR on DCGF in each cohort. Both cohort analyses showed the greatest adverse effect from MVI and eGFR. ACR was also significant in PC and IFTA in CSC. AMR's impact was apparently absorbed by MVI +/o eGFR. Univariate analyses of eGFR had concordances of 0.74 and 0.66 in the P and CSC cohorts. Adding the pathology Factors increased the concordance to 0.79 in both cohorts.

Conclusions: Derivation by FA of Factors and injury scores from KTxBx permits objective assessment of the hazard for subsequent DCGF, with a meaningful increase in concordance over eGFR alone, further refining the identification of KTxBx recipients at high risk for DCGF.

CITATION INFORMATION: Hunsicker L., Grande J., Cecka J., Matas A., The DeKaf Consortium Factor Analysis (FA) of Renal Transplant Biopsy (KTxBx) Data Enables Objective Assessment of Risk for Subsequent Death Censored Graft Failure (DCGF) Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Hunsicker L, Grande J, Cecka J, Matas A, Consortium TheDeKaf. Factor Analysis (FA) of Renal Transplant Biopsy (KTxBx) Data Enables Objective Assessment of Risk for Subsequent Death Censored Graft Failure (DCGF) [abstract]. https://atcmeetingabstracts.com/abstract/factor-analysis-fa-of-renal-transplant-biopsy-ktxbx-data-enables-objective-assessment-of-risk-for-subsequent-death-censored-graft-failure-dcgf/. Accessed November 21, 2024.

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