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100 Protocol Renal Allograft Biopsies at 10 Years: First Look at the Tacrolimus Era

M. Stegall,1 W. Park,1 F. Cosio,2 L. Cornell.3

1Transplant Surgery, Mayo Clinic, Rochester, MN
2Medicine, Mayo Clinic, Rochester, MN
3Laboratory Medicine, Mayo Clinic, Rochester, MN.

Meeting: 2015 American Transplant Congress

Abstract number: B109

Keywords: Glomerular filtration rate (GFR), Graft failure, Kidney transplantation, Renal injury

Session Information

Session Name: Poster Session B: Kidney Complications: Late Graft Failure

Session Type: Poster Session

Date: Sunday, May 3, 2015

Session Time: 5:30pm-6:30pm

 Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

This study examined late renal allograft injury in the Tacrolimus era in 10-yr protocol biopsies (Bx).

Methods One hundred 10-yr protocol allograft bx were assessed using Banff scores/conventional pathology. Between 1/1/2002 and 8/1/2004, 449 adult solitary KTx were performed: 236 did not reach 10 years (101 DWF, 78 Failed, 85 lost to follow-up) leaving 185 KTx, 100 were biopsied. Iothalamate GFR was done in 88% at 5 and 10 yrs. Demographics: Caucasian (93%), male (56%), living donor KTx (83%), Thymoglobulin induction (94%) and Tac, MMF, Pred at 10 yrs (77%).

Results 23% of Bx had only mild chronic changes (cg=0 and chronic scores <1). This group had the highest GFR and lowest proteinuria. 13% had transplant glomerulopathy and 9% had moderate-to-severe interstitial fibrosis (and no cg) with the lowest GFR. In biopsies without cg (n=87), arteriolar hyalinosis was present in 90% (55 were >1) and 68% had increased from 5 years. Global glomerular sclerosis involving >20% of glomeruli was present in 43%. Subclinical inflammation was found in only 4% and recurrence of the primary renal disease was observed in 7%. Importantly, diabetic nephropathy was common (35%), but was not associated with decreased GFR (?hyperfiltration). From 5 to 10 years, 47% had a GFR decline of >10% and 23% an increase >10%. GFR decline was most common in grafts with interstitial fibrosis but not with arteriolar hyalinosis or diabetic nephropathy. 13 had DSA: 4 cg>0, 6 ah>1, 2 cv>1 and 2 only mild changes.

Conclusions 10 yr bx in the Tac era showed a low prevalence of mod/severe fibrosis, TG and subclinical inflammation. The fact that hyalinosis and diabetic nephropathy were common suggests that new approaches to patient management and immunosuppression are warranted to prevent late injury.

Banff Lesions     GFR ml/min δGFR 5/10y 24 hr protein
No Lesions>1(ci/ct/cv/ah≤1; cg=0) 23   66±24 99%±21% 96±26
Transplant glomerulopathy (cg=0) 13   51±25 82%±27% 1760±2648
Mod-Severe Changes (cg=0; other chronic lesions>1) 64        
Interstitial fibrosis (ci>1; cg=0)   9 41±20 64%±25% 1746±2851
Arteriolar hyalinosis (ah>1; cg=0)   55 62±26 95%±32% 468±1216
Arterial sclerosis (cv>1; cg=0)   28 59±21 94%±30% 358±856
Other Diagnoses (in addition to Banff Scores)          
Diabetic nephropathy/mesangial sclerosis; (cg=0)   35 65±29 92%±32% 333±767
Recurrent disease (cg=0)   7 59±28 81%±22% 1166±2914
Sub-clinical inflammation (i&ci>0; cg=0)   4 42±17 78%±11% 460±492
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To cite this abstract in AMA style:

Stegall M, Park W, Cosio F, Cornell L. 100 Protocol Renal Allograft Biopsies at 10 Years: First Look at the Tacrolimus Era [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/100-protocol-renal-allograft-biopsies-at-10-years-first-look-at-the-tacrolimus-era/. Accessed May 31, 2025.

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