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Poor Outcomes in Patients with Transplant Glomerulopathy Independent of Banff Categorization or Therapeutic Interventions

K. Wu1, D. Schmidt1, C. Lopez del Moral1, Q. Zhang1, F. Halleck1, M. G. Naik1, N. Lachmann2, B. Rudolph3, K. Budde1

1Department of Nephrology, Charite Campus Mitte, Berlin, Germany, 2Institut für Transfusionsmedizin, Charite Virchow Klinikum, Berlin, Germany, 3Institut für Pathologie, Charite Campus Mitte, Berlin, Germany

Meeting: 2022 American Transplant Congress

Abstract number: 1411

Keywords: Biopsy, Graft survival, HLA antibodies, Kidney transplantation

Topic: Clinical Science » Kidney » 45 - Kidney Chronic Antibody Mediated Rejection

Session Information

Session Name: Kidney Chronic Antibody Mediated Rejection

Session Type: Poster Abstract

Date: Monday, June 6, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Banff classification is an accepted diagnostic tool, but also used as a tool to define endpoints in clinical trials. There is a need to investigate whether transplant glomerulopathy (TG) is suited as a robust surrogate endpoint to predict long-term graft outcomes.

*Methods: According to the Banff’17 criteria, the first biopsy-proven TG of 282 kidney allograft recipients with complete follow-up was investigated and patients were divided into three groups: chronic antibody-mediated rejection (cAMR, n=72), chronic active antibody-mediated rejection (cAAMR, n=76), and isolated transplant glomerulopathy (iTG, n=134). In addition, 25 cAMR and 46 cAAMR patients received antihumoral therapy (AHT) primarily consisting of high-dose intravenous immunoglobulin and plasmapheresis.

*Results: There were no significant differences in clinical characteristics, allograft function, and clinical outcomes among three TG groups (figure 1). Interestingly, cAMR and cAAMR patients receiving AHT had comparable 5-year death-censored graft survival (DCGS) rates compared to patients without AHT, and similar in comparison to patients with iTG (figure 2). The Banff TG score was not associated with DCGS (Table 1); the Cox-regression analysis demonstrated that Banff mm-, ci- and ct-lesions were closely associated with graft failure at 5-year post studied biopsy.

*Conclusions: The occurrence of TG is associated with poor long-term outcomes independent of the Banff categorization or score or AHT. The Banff lesion scores indicating chronic allograft scarring might be better suited to predict an unfavorable outcome.

Table 1: The role of the Banff lesion score on the DCGS rates (%) at 5-year post studied biopsy
iTG

% (patients number)
cAMR

% (patients number)
cAAMR% (patients number)

Overall 

% (patients number)
cg1 44.4% (n=36) 37.5% (n=16) 28.6% (n=7) 40.7% (n=59)
cg2 23.6% (n=55) 39.1% (n=23) 52.6% (n=19) 33.0% (n=97)
cg3 39.4% (n=40) 44.0% (n=25) 22.5% (n=40) 33.7 (n=98)
Log rank p-value 0.50 0.84 0.34 0.45

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To cite this abstract in AMA style:

Wu K, Schmidt D, Moral CLopezdel, Zhang Q, Halleck F, Naik MG, Lachmann N, Rudolph B, Budde K. Poor Outcomes in Patients with Transplant Glomerulopathy Independent of Banff Categorization or Therapeutic Interventions [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/poor-outcomes-in-patients-with-transplant-glomerulopathy-independent-of-banff-categorization-or-therapeutic-interventions/. Accessed May 30, 2025.

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