Subclinical Rejection Phenotypes at 1 Year Post-Transplant and Outcome of Kidney Allografts

亚临床感染 医学 肾移植 移植 内科学 前瞻性队列研究 蛋白尿 胃肠病学 肾小球疾病 泌尿科
作者
Alexandre Loupy,Déwi Vernerey,Claire Tinel,Olivier Aubert,Jean‐Paul Duong Van Huyen,Marion Rabant,Jérôme Verine,Dominique Nochy,Jean‐Philippe Empana,Frank Martinez,Denis Glotz,Xavier Jouven,Christophe Legendre,Carmen Lefaucheur
出处
期刊:Journal of The American Society of Nephrology 卷期号:26 (7): 1721-1731 被引量:273
标识
DOI:10.1681/asn.2014040399
摘要

Kidney allograft rejection can occur in clinically stable patients, but long-term significance is unknown. We determined whether early recognition of subclinical rejection has long-term consequences for kidney allograft survival in an observational prospective cohort study of 1307 consecutive nonselected patients who underwent ABO-compatible, complement-dependent cytotoxicity-negative crossmatch kidney transplantation in Paris (2000-2010). Participants underwent prospective screening biopsies at 1 year post-transplant, with concurrent evaluations of graft complement deposition and circulating anti-HLA antibodies. The main analysis included 1001 patients. Three distinct groups of patients were identified at the 1-year screening: 727 (73%) patients without rejection, 132 (13%) patients with subclinical T cell-mediated rejection (TCMR), and 142 (14%) patients with subclinical antibody-mediated rejection (ABMR). Patients with subclinical ABMR had the poorest graft survival at 8 years post-transplant (56%) compared with subclinical TCMR (88%) and nonrejection (90%) groups (P<0.001). In a multivariate Cox model, subclinical ABMR at 1 year was independently associated with a 3.5-fold increase in graft loss (95% confidence interval, 2.1 to 5.7) along with eGFR and proteinuria (P<0.001). Subclinical ABMR was associated with more rapid progression to transplant glomerulopathy. Of patients with subclinical TCMR at 1 year, only those who further developed de novo donor-specific antibodies and transplant glomerulopathy showed higher risk of graft loss compared with patients without rejection. Our findings suggest that subclinical TCMR and subclinical ABMR have distinct effects on long-term graft loss. Subclinical ABMR detected at the 1-year screening biopsy carries a prognostic value independent of initial donor-specific antibody status, previous immunologic events, current eGFR, and proteinuria.
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