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Early interstitial macrophage infiltration with mild dysfunction is associated with subsequent kidney graft loss
Author(s) -
Paoletti Ernesto,
Bussalino Elisabetta,
Bellino Diego,
Tagliamacco Augusto,
Bruzzone Marco,
Ravera Maura,
Parodi Angelica,
Fontana Iris,
Gaggero Gabriele,
Garibotto Giacomo,
Ravetti Jean Louis
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13579
Subject(s) - medicine , cd68 , biopsy , infiltration (hvac) , urology , kidney , kidney transplantation , proteinuria , nephrology , gastroenterology , pathology , surgery , immunohistochemistry , physics , thermodynamics
Macrophage infiltration is associated with unfavorable kidney graft outcome in protocol biopsies, but few studies have evaluated its impact on clinical practice. We therefore prospectively evaluated 37 kidney transplant recipients (KTRs) who underwent kidney biopsy due to slight increases in serum creatinine, or mild proteinuria (>0.3 g/24 hr), in the first post‐transplant year. Banff score, CD68 + count (score 0‐3) by immunohistochemistry, and 1‐year DSA were assessed. DGF was reported in 10 (27%) patients, 6 (16%) had normal biopsy, 7 (19%) borderline lesions, 13 (35%) IFTA, and 11 (30%) other lesions. Fifteen KTRs had grade 3 CD68 + infiltration, and 47% developed de novo DSA. During a 6.2 ± 2.7 year follow‐up, four patients (11%) suffered from biopsy‐proven T‐cell rejection, 17 KTRs (46%) lost their graft (12 in the grade 3 CD68 + group). Graft survival was lower in KTRs with grade 3 CD68 + infiltration ( P = 0.0074; log‐rank test). Grade 3 CD68 + infiltrate was an independent predictor of graft loss (HR 5.41, 95% CI 1.74‐16.8; P = 0.003), together with more severe graft dysfunction at biopsy (HR 6.41, 95% CI 2.57‐16; P < 0.001). We conclude that grade 3 CD68 + interstitial infiltration is associated with increased risk of subsequent graft loss independent of other factors.