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Title: | Decreased kidney graft survival in low immunological risk patients showing inflammation in normal protocol biopsies |
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Author: | Ortiz, Fernanda; Gelpi, Rosana; Helanterä, Ilkka; Melilli, Edoardo; Honkanen, Eero; Bestard Matamoros, Oriol; Grinyó Boira, Josep M.; Cruzado, Josep Ma. |
Other authors: | Universitat de Barcelona |
Abstract: | Introduction The pros and cons for implementing protocol biopsies (PB) after kidney transplantation are still a matter of debate. We aimed to address the frequency of pathological findings in PB, to analyze their impact on long-term graft survival (GS) and to analyze the risk factors predicting an abnormal histology. Methods We analyzed 946 kidney PB obtained at a median time of 6.5 (±2.9) months after transplantation. Statistics included comparison between groups, Kaplan-Meier and multinomial logistic regression analysis. Results and Discussion PB diagnosis were: 53.4% normal; 46% IFTA; 12.3% borderline and 4.9% had subclinical acute rejection (SCAR). Inflammation had the strongest negative impact on GS. Therefore we split the cases into: "normal without inflammation", "normal with inflammation", "IFTA without inflammation", "IFTA with inflammation" and "rejection" (including SCAR and borderline). 15-year GS in PB diagnosed normal with inflammation was significantly decreased in a similar fashion as in rejection cases. Among normal biopsies, inflammation increased significantly the risk of 15-y graft loss (P = 0.01). Variables that predicted an abnormal biopsy were proteinuria, previous AR and DR-mismatch. Conclusion We conclude that inflammation in normal PB is associated with a significantly lower 15-y GS, comparable to rejection or IFTA with inflammation. |
Subject(s): | -Inflamació -Biòpsia -Histologia -Inflammation -Biopsy -Histology |
Rights: | cc-by (c) Ortiz, Fernanda et al., 2016
http://creativecommons.org/licenses/by/3.0/es |
Document type: | Article Article - Published version |
Published by: | Public Library of Science (PLoS) |
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