期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 12, 期 2, 页码 388-399出版社
WILEY-BLACKWELL
DOI: 10.1111/j.1600-6143.2011.03840.x
关键词
Allograft failure; antibody-mediated rejection; kidney transplantation; nonadherence
资金
- Bristol-Meyers Squibb
- Genome Canada
- University of Alberta
- University of Alberta Hospital Foundation
- Alberta Advanced Education and Technology
- Roche Molecular Systems
- Hoffmann-La Roche Canada Ltd.
- Alberta Ministry of Advanced Education and Technology
- Roche Organ Transplant Research Foundation
- Kidney Foundation of Canada
- Astellas Canada
We prospectively studied kidney transplants that progressed to failure after a biopsy for clinical indications, aiming to assign a cause to every failure. We followed 315 allograft recipients who underwent indication biopsies at 6 days to 32 years posttransplant. Sixty kidneys progressed to failure in the follow-up period (median 31.4 months). Failure was rare after T-cellmediated rejection and acute kidney injury and common after antibody-mediated rejection or glomerulonephritis. We developed rules for using biopsy diagnoses, HLA antibody and clinical data to explain each failure. Excluding four with missing information, 56 failures were attributed to four causes: rejection 36 (64%), glomerulonephritis 10 (18%), polyoma virus nephropathy 4 (7%) and intercurrent events 6 (11%). Every rejection loss had evidence of antibody-mediated rejection by the time of failure. Among rejection losses, 17 of 36 (47%) had been independently identified as nonadherent by attending clinicians. Nonadherence was more frequent in patients who progressed to failure (32%) versus those who survived (3%). Pure T-cellmediated rejection, acute kidney injury, drug toxicity and unexplained progressive fibrosis were not causes of loss. This prospective cohort indicates that many actual failures after indication biopsies manifest phenotypic features of antibody-mediated or mixed rejection and also underscores the major role of nonadherence.
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