Aim: Study factors that are associated with transplant glomerulopathy (TG) in flowcytometric crossmatch negative kidney transplant recipients with no desensitization.

Methods:Single center retrospective analysis of characteristics and outcomes of kidney transplants with available HLA data 9/2011-4/2015. Single antigen bead studies were done pre transplant and at 4 months, 1 and 2 years. Flowcytometric crossmatch was done at time of transplant. For cause and surveillance biopsies were obtained at 4 months, 1 and 2 years and scored by Banff criteria. TG was was considered if present at 1 or 2 surveillance biopsy. Antibodies were considered DSAs if MFIs>500. Follow up was through 8/2016. Antibodies posttransplant were considered de novo (dnDSA) if they were not present pretransplant.

Results:Biopsy data at 1 and/or 2 yrs was available on 296 patients, 27(9.1%) developed TG. TG group had longer cold ischemia and inflammation at 4 month (ptc>0,g>0,v>0,i>0,t>0). Rejection in first yr and AMR were also more common. There was no significant difference in cPRA>20%, glomerulonephritis, retransplants, female gender or immunosuppression induction and steroid avoidance. Antibodies pretransplant or de novo were not significantly different but the presence of both pre-DSA and dnDSA as well dnDSA class II were significantly higher in TG group.Stepwise logistic regression was done and only glomerulitis and peritubular capillaritis were independently associated with TG at 1 or 2 yrs, g>0 OR 6.1(1.57-23.7) and ptc>0 OR 4.85(1.74-13.6).ROC AUC 0.72.

Conclusion:Microvascular inflammation at 4 months posttransplant independently predicted TG at 1 and 2 years.

CITATION INFORMATION: Khamash H, Mour G, Archambault L, Buras M, Kosiorek H, Pando M, Reddy K, Chakkera H, Huskey J, Nair S, Jaramillo A, Smith M, Kaplan B, Heilman R. Microvascular Inflammation at 4 Months Posttransplant Is Associated with Transplant Glomerulopathy at One and Two Years Independent of Rejection and Donor Specific Antibodies. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress