Transplant glomerulopathy: clinical course and factors relating to graft survival

Abstract

Introduction: Transplant glomerulopathy (TG) is usually associated with a poor prognosis for kidney graft survival.

Aim and methods: We analyzed 30 cases of TG diagnosed by kidney biopsy among a retrospective review of 579 biopsies performed between January 2006 and October 2011.

Results: At the time of biopsy, the mean glomerular filtration rate (GFR), estimated by the abbreviated Modification of Diet in Renal Disease was 31 ± 10 mL/min and the proteinuria, 1.9 ± 2 gr/24 hours. Anti-human leukocyte antigen (HLA) antibodies were present in 40% of patients. The histological findings showed severe duplication of the glomerular basement membrane in 80% of patients; and interstitial fibrosis and tubular atrophy (IFTA) and moderate to severe arteriolar hyalinosis in 53% and 56% respectively. Fourteen patients lost their grafts. Graft survival was significantly associated with IFTA (P = .03) and renal function at the time of diagnosis (P = .03).

Conclusions: TG was associated with a worse prognosis for the graft among kidney transplant patients. It is often associated with the presence of anti-HLA antibodies. Renal function at the time of diagnosis and IFTA were predictive factors for graft survival in these patients.