Deteriorating renal function either evidenced by a rise in serum creatinine or proteinuria remains the most important indication for a late transplant biopsy. Over the last 4 years we have performed 148 “for cause” biopsies at our centre. In this study we analyse the histology of the biopsies in relation to the presenting indication. We have also collected serum samples for the detection of Donor Specific Antibody (DSA). The allografts were classified into those with acute dysfunction (AD, n=15), creeping creatinine (CC, n=29), isolated proteinuria (P, n=46) and proteinuria with creeping creatinine (P+CC, n=58). Creeping creatinine was defined as a slope >0.35 and P<0.05 on the regression analysis of 1/creatinine values over 2 years prior to the biopsy. Patients with≥3 urine protein estimates of>0.5g/day had significant proteinuria. We have found that the histology was quite heterogeneous with no relation to the indication.

In 116 patients with IFTA/microcirculation damage (MCI=g/cg/ptc≥1)/late T cell rejection BANFF scores were largely similar.

In 53 patients with MCI, c4d deposition in the peritubular capillaries remained the single most important predictor for outcomes over a 2year follow-up period. There was a trend towards worse survival in patients with higher degree of scarring with clinical presentation not having any impact on the outcome.

In summary, we propose that the histology of late “for cause” biopsies is heterogeneous irrespective of the indication and key histological features rather than clinical presentation affects the short term outcomes.

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