100 Protocol Renal Allograft Biopsies at 10 Years: First Look at the Tacrolimus Era
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
Date: Sunday, May 3, 2015
Session Name: Poster Session B: Kidney Complications: Late Graft Failure
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 |
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 March 8, 2021.« Back to 2015 American Transplant Congress