Long-term Trends in the Clinicopathologic Features of Kidney Transplant Recipients With Graft Dysfunction

Yu Ho Lee, Jung Jun Lee, So Young Lee, Su Woong Jung, Yang Gyun Kim, Ju Young Moon, Jin Sug Kim, Hyeon Seok Hwang, Kyung Hwan Jeong, Byung Ha Chung, Chan Duck Kim, Jae Berm Park, Yeong Hoon Kim, Dong Ho Yang, Sang Ho Lee

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Graft biopsy is the gold standard for the differential diagnosis of graft dysfunction. The time interval between transplant surgery and biopsy often provides clinicians with diagnostic clues. However, the clinicopathologic features of late graft biopsy, especially those obtained at more than 5 years after kidney transplant, are not well understood. Materials and Methods: We retrospectively collected graft biopsy tissues obtained from kidney transplant recipients who underwent indication biopsy between February 2012 and March 2017. Patients were divided according to their post-transplant period, and their clinical characteristics, pathologic diagnosis, and Banff scores were compared across groups. Results: A total of 410 indication biopsy specimens obtained from 321 kidney transplant recipients were analyzed in this study. Overall, the incidence of T cell–mediated rejection, borderline rejection, and BK virus–associated nephropathy decreased while that of antibody-mediated rejection, nonspecific interstitial fibrosis and tubular atrophy, and glomerulonephritis increased over time. Most samples obtained over 5 years after kidney transplant exhibited chronic glomerular and tubulointerstitial injuries irrespective of their pathologic diagnosis. In patients whose post-transplant period was less than 5 years, urine protein-to-creatinine ratio was significantly elevated in the glomerulonephritis and chronic active antibody-mediated rejection groups only. In contrast, patients who underwent graft biopsy more than 5 years after kidney transplant showed significantly high levels of proteinuria irrespective of the pathologic diagnosis, and there was no statistical difference between groups. Conclusion: We demonstrated that the etiology of graft dysfunction is largely influenced by the biopsy time point.

Original languageEnglish
Pages (from-to)3297-3303
Number of pages7
JournalTransplantation Proceedings
Volume51
Issue number10
DOIs
StatePublished - Dec 2019

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