Transplant glomerulopathy (TG) is a histological pattern characterized by duplication of glomerular basement membrane. Chronic antibody-mediated injury is a major cause for its development. Risk factors of allograft failure following TG have not been well defined.

We reviewed 1599 consecutive for-cause kidney allograft biopsies at our center (1/2000-6/2011) and identified 96 recipients with TG. Relevant clinical, histological, laboratory and outcome information were obtained. We did Cox regression to identify independent risk factors for graft failure.

TG was diagnosed 43 mo (median) after transplant. Glomerulitis was present in 68 (71%); peritubular capillary (PTC) inflammation-62 (65%); tubulitis/interstitial inflammation-39 (41%); severe interstitial fibrosis (IF/TA)-22 (23%), and severe vascular fibrous intimal thickening in 19 (20%).

Among the 96 patients, 55 (57%) had PTC basement membrane multilayering and 36 (38%) had positive C4d staining. Information on donor specific antibody was available in 35 (36%) recipients and was positive in 24 (69%). Biopsy showed acute injury in 86 (90%). Forty four (51%) received specific therapy comprised of combinations of pulse steroids, plasmapheresis, antithymocyte globulin, intravenous immunoglobulin, rituximab or bortezomib.

Patients were followed for 44 mo (median) after biopsy diagnosis. There were 36 (38%) allograft failures within 1 year of biopsy. Median allograft survival was 28 months post-biopsy.

By Cox regression, IF/TA was the only histopathology finding that was associated with allograft failure.

In our single-center analysis of 1599 renal allograft biopsies, we identified 96 transplant recipients with TG. One-year post-biopsy allograft survival was 62%. eGFR, proteinuria at the time of biopsy and IF/TA were independently associated with allograft outcome.

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