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Mesangial expansion at 5 years predicts death and death‐censored graft loss after renal transplantation
Author(s) -
Kukla Aleksandra,
Alexander Mariam P.,
TurkeviNagy Sandor,
Merzkani Massini,
Park Walter,
Smith Byron,
Zhang Pingchuan,
Benavides Xiomara,
D'Costa Matthew,
Morales Alvarez Catalina,
Denic Aleksandar,
Bentall Andrew,
Kudva Yogish C.,
Stegall Mark
Publication year - 2021
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.14147
Subject(s) - medicine , transplantation , cohort , obesity , kidney transplantation , retrospective cohort study , renal function , diabetes mellitus , cohort study , cause of death , gastroenterology , endocrinology , disease
Death with a functioning graft and death‐censored renal allograft failure remain major problems for which effective preventative protocols are lacking. The retrospective cohort study aimed to determine whether histologic changes on a 5‐year surveillance kidney biopsy predict adverse outcomes after transplantation in recipients who had: both Type 2 diabetes (T2DM) and obesity (BMI ≥ 30 kg/m 2 ) at the time of transplantation (T2DM/Obesity, n = 75); neither (No T2DM/No obesity, n = 78); No T2DM/Obesity ( n = 41), and T2DM/No obesity ( n = 47). On 5‐year biopsies, moderate‐to‐severe mesangial expansion was more common in the T2DM/Obesity group (Banff mm score ≥2 = 49.3%; Tervaert classification MS ≥ 2b = 26.7%) compared to the other groups ( p < .001 for both scores). Risk factors included older age, higher BMI, HbA1C, and triglycerides at 1‐year post‐transplant. Moderate‐to‐severe mesangial expansion correlated with death with function (HR 1.74 (1.01, 2.98), p = .045 Banff and 1.89 (1.01, 3.51) p = .045 Tervaert) and with death‐censored graft loss (HR 3.2 (1.2, 8.8), p = .02 Banff and HR 3.8 (1.3, 11.5), p = .01 Tervaert) over a mean of 11.6 years of recipient follow‐up post‐transplant. These data suggest that mesangial expansion in recipients with T2DM and obesity may reflect systemic vascular injury and might be a novel biomarker to predict adverse outcomes post renal transplant.