Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes
Abstract Introduction: Renal fibrosis is the end point of a process that begins at transplant, with ischemia reperfusion and early inflammation, and progresses over time with immunological and non-immunological phenomena. Early identification of morphological markers and intervention could improve...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Nefrologia
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| Series: | Brazilian Journal of Nephrology |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019005028103&lng=en&tlng=en |
| _version_ | 1818309964972687360 |
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| author | Marcos Vinicius de Sousa Ricardo de Lima Zollner Marilda Mazzali |
| author_facet | Marcos Vinicius de Sousa Ricardo de Lima Zollner Marilda Mazzali |
| author_sort | Marcos Vinicius de Sousa |
| collection | DOAJ |
| description | Abstract Introduction: Renal fibrosis is the end point of a process that begins at transplant, with ischemia reperfusion and early inflammation, and progresses over time with immunological and non-immunological phenomena. Early identification of morphological markers and intervention could improve graft function and survival. Objective: to evaluate the correlation between intensity and specificity of pre-transplant anti-HLA antibodies and kidney allograft pathology in order to identify early risk factors or markers of allograft dysfunction. Methods: A retrospective cohort of kidney transplant recipients with pre-transplant anti-HLA antibodies who underwent graft biopsy within the first two years post-transplant was divided into two groups according to the specificity of anti-HLA antibodies: nonspecific (non-DSA, n = 29) and specific (DSA+, n = 16). Kidney graft pathology, renal function, and proteinuria were analyzed. Results: general characteristics were similar in both groups, except for the higher dose of thymoglobulin in DSA+ group (p < 0.05). The non-DSA group had higher scores for glomerulosclerosis, interstitial inflammation (i) and interstitial fibrosis (ci) (p < 0.05) and higher incidence of cell-mediated acute rejection. No statistical difference in incidence of antibody-mediated rejection, renal function, and proteinuria was observed during follow up. Discussion and conclusions: the difference in inflammation scores and interstitial fibrosis may be associated to the higher incidence of acute cell-mediated rejection and polyomavirus nephropathy in the Non-DSA group. We also should take into account the protective effect of higher doses of thymoglobulin, reducing ischemia reperfusion injury in the DSA+ group. The short follow-up might have been insufficient to detect long-term changes in allograft tissue, renal function, and proteinuria. |
| first_indexed | 2024-12-13T07:38:32Z |
| format | Article |
| id | doaj.art-6f28a1b38123496da803afd9ebba5bbe |
| institution | Directory Open Access Journal |
| issn | 2175-8239 |
| language | English |
| last_indexed | 2024-12-13T07:38:32Z |
| publisher | Sociedade Brasileira de Nefrologia |
| record_format | Article |
| series | Brazilian Journal of Nephrology |
| spelling | doaj.art-6f28a1b38123496da803afd9ebba5bbe2022-12-21T23:55:01ZengSociedade Brasileira de NefrologiaBrazilian Journal of Nephrology2175-823910.1590/2175-8239-jbn-2018-0244S0101-28002019005028103Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomesMarcos Vinicius de SousaRicardo de Lima ZollnerMarilda MazzaliAbstract Introduction: Renal fibrosis is the end point of a process that begins at transplant, with ischemia reperfusion and early inflammation, and progresses over time with immunological and non-immunological phenomena. Early identification of morphological markers and intervention could improve graft function and survival. Objective: to evaluate the correlation between intensity and specificity of pre-transplant anti-HLA antibodies and kidney allograft pathology in order to identify early risk factors or markers of allograft dysfunction. Methods: A retrospective cohort of kidney transplant recipients with pre-transplant anti-HLA antibodies who underwent graft biopsy within the first two years post-transplant was divided into two groups according to the specificity of anti-HLA antibodies: nonspecific (non-DSA, n = 29) and specific (DSA+, n = 16). Kidney graft pathology, renal function, and proteinuria were analyzed. Results: general characteristics were similar in both groups, except for the higher dose of thymoglobulin in DSA+ group (p < 0.05). The non-DSA group had higher scores for glomerulosclerosis, interstitial inflammation (i) and interstitial fibrosis (ci) (p < 0.05) and higher incidence of cell-mediated acute rejection. No statistical difference in incidence of antibody-mediated rejection, renal function, and proteinuria was observed during follow up. Discussion and conclusions: the difference in inflammation scores and interstitial fibrosis may be associated to the higher incidence of acute cell-mediated rejection and polyomavirus nephropathy in the Non-DSA group. We also should take into account the protective effect of higher doses of thymoglobulin, reducing ischemia reperfusion injury in the DSA+ group. The short follow-up might have been insufficient to detect long-term changes in allograft tissue, renal function, and proteinuria.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019005028103&lng=en&tlng=enHLA AntigensGraft RejectionFibrosisProteinuriaReperfusion InjuryBiopsy |
| spellingShingle | Marcos Vinicius de Sousa Ricardo de Lima Zollner Marilda Mazzali Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes Brazilian Journal of Nephrology HLA Antigens Graft Rejection Fibrosis Proteinuria Reperfusion Injury Biopsy |
| title | Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes |
| title_full | Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes |
| title_fullStr | Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes |
| title_full_unstemmed | Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes |
| title_short | Renal transplant patients with preformed anti-HLA antibodies: early biopsy findings and clinical outcomes |
| title_sort | renal transplant patients with preformed anti hla antibodies early biopsy findings and clinical outcomes |
| topic | HLA Antigens Graft Rejection Fibrosis Proteinuria Reperfusion Injury Biopsy |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002019005028103&lng=en&tlng=en |
| work_keys_str_mv | AT marcosviniciusdesousa renaltransplantpatientswithpreformedantihlaantibodiesearlybiopsyfindingsandclinicaloutcomes AT ricardodelimazollner renaltransplantpatientswithpreformedantihlaantibodiesearlybiopsyfindingsandclinicaloutcomes AT marildamazzali renaltransplantpatientswithpreformedantihlaantibodiesearlybiopsyfindingsandclinicaloutcomes |