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Predictors of chronic allograft nephropathy from protocol biopsies using histological and immunohistochemical techniques
Author(s) -
YEHIA MAHA,
MATHESON PHILIP J,
MERRILEES MERVYN J,
BEAUMONT BRENT W,
PILMORE HELEN L
Publication year - 2006
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2006.00561.x
Subject(s) - medicine , chronic allograft nephropathy , nephropathy , cd68 , pathology , immunohistochemistry , biopsy , urology , gastroenterology , transplantation , kidney transplantation , endocrinology , diabetes mellitus
SUMMARY: Aim: Chronic allograft nephropathy is a predictor of poor allograft survival. Protocol and diagnostic biopsies were used to identify markers contributing to its pathogenesis. Methods: Diagnostic, 3‐ and 12‐month protocol biopsies in renal transplant recipients were examined. Immunohistochemical staining with monoclonal antibodies for memory T cells (CD45RO), macrophages (CD68) and alpha smooth muscle actin was undertaken on protocol biopsies. Results: Protocol biopsies revealed the incidence of chronic allograft nephropathy to be 10.7% (3/28) at 3 and 57.6% (19/33) at 12 months. There was a trend towards a higher serum creatinine in patients with chronic allograft nephropathy compared with those without (0.15 ± 0.04 vs 0.12 ± 0.04 mmol/L, P = 0.047). The strongest predictor of chronic allograft nephropathy at 12 months was the presence of arteriolar hyaline change ( P = 0.035; odds ratio 1.22, 95% CI 0.036–0.887) whereas a higher CD45RO and CD68 count at 12 months was associated with chronic allograft nephropathy (74.7 ± 56.9 cells/mm 2 and 22.4 ± 23.5 cells/mm 2 ) compared with patients without it (29.2 ± 29.2 cells/mm 2 and 8.3 ± 9.9 cells/mm 2 , P = 0.006 and P = 0.03, respectively). The number of smooth muscle actin positive cells correlated significantly with chronic allograft nephropathy at 12 month (107.6 ± 44 vs 73.9 ± 20.8 cells/mm 2 , P = 0.009). Conclusion: The high prevalence of chronic allograft nephropathy in renal transplant recipients is associated with renal dysfunction. Arteriolar hyalinosis was the most significant predictor at 12 months. There was a significantly higher macrophage and T cell infiltrate in stable grafts undergoing chronic allograft nephropathy at 12 months post transplant.