The histological picture of indication biopsies in the first 2 weeks after kidney transplantation

Elisabet Van Loon, Evelyne Lerut, Aleksandar Senev, Maarten Coemans, Jacques Pirenne, Diethard Monbaliu, Ina Jochmans, Mauricio Sainz Barriga, Katrien De Vusser, Amaryllis H. Van Craenenbroeck, Ben Sprangers, Marie Paule Emonds, Dirk Kuypers, Maarten Naesens*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background and objectives In preclinical studies, ischemia-reperfusion injury and older donor age are associated with graft inflammation in the early phase after transplantation. In human kidney transplantation, impaired allograft function in the first days after transplantation is often adjudicated to donor-and procedure-related characteristics, such as donor age, donor type, and ischemia times. Design, setting, participants, & measurements In a cohort of 984 kidney recipients, 329 indication biopsies were performed within the first 14 days after transplantation. The histologic picture of these biopsies and its relationship with alloimmune risk factors and donor-and procedure-related characteristics were studied, as well as the association with graft failure. Multivariable Cox models were applied to quantify the cause-specific hazard ratios for early rejection and early inflammatory scores, adjusted for potential confounders. For quantification of hazard ratios of early events for death-censored graft failure, landmark analyses starting from day 15 were used. Results Early indication biopsy specimens displayed microvascular inflammation score $2 in 30% and tubulointerstitial inflammation score $2 in 49%. Rejection was diagnosed in 186 of 329 (57%) biopsies and associated with the presence of pretransplant donor-specific HLA antibodies and the number of HLA mismatches, but not nonimmune risk factors in multivariable Cox proportional hazards analysis. In multivariable Cox proportional hazards analysis, delayed graft function, the graft dysfunction that prompted an early indication biopsy, HLA mismatches, and pretransplant donor-specific HLA antibodies were significantly associated with a higher risk for death-censored graft failure, whereas early acute rejection was not. Conclusions Indication biopsies performed early after kidney transplantation display inflammatory changes related to alloimmune risk factors. Nonimmune risk factors for ischemia-reperfusion injury, such as cold and warm ischemia time, older donor age, and donor type, were not identified as strong risk factors for early inflammation after human kidney transplantation.

Original languageEnglish (US)
Pages (from-to)1484-1493
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume15
Issue number10
DOIs
StatePublished - 2020

Funding

This study was funded by the Research Foundation–Flanders (Fonds Wetenschappelijk Onderzoek [FWO]) and Flanders Innovation and Entrepreneurship (VLAIO) with a TBM (Toegepast Biomedisch onderzoek met een primair Maatschappelijke finaliteit) project (grant IWT.150199), awarded to M. Naesens. This study was also funded by Onderzoeksraad, KU Leuven grant C32/17/049. E.VanLoonholdsanFWOfellowshipgrant(1143919N).M.Naesens and B. Sprangers are senior clinical investigators of FWO (grants 1844019N and 1842919N).

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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