Pediatric Kidney Allograft Outcomes Following Identification of Transplant Glomerulopathy by Electron Microscopy
LSU Health Sciences Center, New Orleans, LA.
Meeting: 2018 American Transplant Congress
Abstract number: B256
Keywords: Graft failure, Kidney transplantation, Pediatric, Renal dysfunction
Session Information
Session Name: Poster Session B: Kidney: Pediatrics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
We have previously shown that electron microscopy (EM) can facilitate early diagnosis of transplant glomerulopathy (TG) in pediatric kidney transplant biopsies (Bx) with normal light microscopy (LM) in up to 30% of patients (pts). This is a follow-up report on 12-mo graft outcomes based on TG status on index Bx.
Pts underwent Bx for clinical care between 6-2014 and 10-2016. Bx were stratified into 3 groups: no TG on EM or LM, TG on EM only, and TG on LM. Pts with acute rejection on f/u Bx within 12 mo of index Bx were excluded. Kruskal-Wallis and chi-square tests were used for baseline comparisons. Kaplan-Meier survival analysis was used to analyze graft outcome – ESRD or doubling of serum creatinine (SCr).
Thirty-three patients were included. Baseline comparisons showed no difference at time of Bx.
| Baseline features
Median (IQR), or % |
No TG (N=11) | TG on EM only (N=8) | TG on LM (N=14) | P-value |
| Age (yrs) | 17 (13-18) | 18.5 (13.5-20) | 16.5 (15-20) | 0.8 |
| Time since Tx (wks) | 116 (54-218) | 213 (89-766) | 194 (78-375) | 0.2 |
| eGFR (ml/min/1.73m2) | 38 (30-69) | 32 (24-44) | 40 (23-47) | 0.6 |
| Gender (Male) | 73% | 63% | 71% | 0.9 |
| Proteinuria =>1+ (YES) | 25% | 29% | 55% | 0.3 |
| SCr elevated from baseline (YES) | 82% | 88% | 86% | 0.9 |
| DSA (YES) | 45% | 38% | 71% | 0.2 |
| ACR/BCR on index Bx (YES) | 55% | 75% | 93% | 0.1 |
| AHR on index Bx (YES) | 18% | 38% | 50% | 0.3 |
Outcome:
No TG: 2 pts lost to f/u at 4 and 9 mo due to transition of care were censored, and 1 pt progressed to ESRD at 6 mo (11%).
TG by EM only: 1 pt lost to f/u at 3 mo. Two pts progressed to ESRD at 6 and 11 mo, and 1 doubled SCr at 12 mo (43%).
TG by LM: 4 pts reached ESRD at 1, 6, 9 and 10 mo and 1 pt doubled SCr at 6 mo (36%).
There was no difference between groups (p-value 0.35) though our study was underpowered.
In conclusion, we observed high rates of graft loss in pts with TG whether detected early only on EM or advanced on LM. Analysis of a larger cohort is needed to confirm these findings.
CITATION INFORMATION: Grodsky J., Craver R., Ashoor I. Pediatric Kidney Allograft Outcomes Following Identification of Transplant Glomerulopathy by Electron Microscopy Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Grodsky J, Craver R, Ashoor I. Pediatric Kidney Allograft Outcomes Following Identification of Transplant Glomerulopathy by Electron Microscopy [abstract]. https://atcmeetingabstracts.com/abstract/pediatric-kidney-allograft-outcomes-following-identification-of-transplant-glomerulopathy-by-electron-microscopy/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress