12 September 2013 : Original article
Doubling of serum creatinine as an outcome after renal transplant – pathological evidence of graft biopsy
Shang-Feng TsaiABCDEF, Kuo-Hsiung ShuBD, Hao-Chung HoBD, Cheng-Hsu ChenBD, Ming-Ju WuBD, Mei-Chin WenBCDOI: 10.12659/AOT.889098
Ann Transplant 2013; 18:471-481
Abstract
BACKGROUND: Doubling of serum creatinine (DSC) in transplantation has been seen as the end-point of renal function without pathological evidence. We conducted this study to elucidate the relationship between DSC and pathological findings.
MATERIAL AND METHODS: We conducted a retrospective cohort study to illustrate pathologic changes in patients receiving a kidney biopsy in the previous 5 years with clinicopathological correlations to DSC and proteinuria.
RESULTS: Of a total of 99 kidney recipients (146 biopsies), results of graft biopsy were as follows: calcineurin inhibitor toxicity (CNI) (38.7%) and rejection (36.9%). Compared to males, females had higher proportions of class I (p=0.003) and class II PRA (p<0.001), and a higher rejection rate (p=0.042), but had the same clinical outcomes as males, like eGFR at follow-up (p=0.882), DSC (p=0.703), and proteinuria (p=0.745). Pathological diagnoses and findings were related to proteinuria: glomerulopathy (HR=4.9, p=0.01), AMR (HR=2.5, p=0.025), especially acute AMR (HR=2.9, p=0.008), chronic glomerular change (HR=10.2, p=0.002), arteriolar hyaline (HR=2.3, p=0.026), and mesangial matrix change (HR=6.3, p=0.002). BK nephropathy and rejection were the only 2 risk factors. Pathological findings favoring AMR (PTC infiltration and glomerulitis) showed a greater risk of DSC compared with those favoring CMR (interstitial inflammation, intimal arteritis, and tubulitis). DSC was correlated with clinical manifestation (rejection) and provided strong pathological evidence.
CONCLUSIONS: There was more acute rejection and chronic pathological change in women, but outcomes were the same due to less activity of renin-angiotensin-aldosterone and hyperfiltration in females. DSC as an end-point of graft function can be used to identify recipients, especially AMR or mixed AMR and CMR. 1. All forms of support received by each author: None of the authors received support. 2. Any potential conflict of interest for each author: No conflict of interest for any of the authors.
Keywords: Recipient, graft biopsy, doubling of serum creatinine, renal transplantation
In Press
18 Mar 2024 : Original article
Does Antibiotic Use Increase the Risk of Post-Transplantation Diabetes Mellitus? A Retrospective Study of R...Ann Transplant In Press; DOI: 10.12659/AOT.943282
20 Mar 2024 : Original article
Transplant Nephrectomy: A Comparative Study of Timing and Techniques in a Single InstitutionAnn Transplant In Press; DOI: 10.12659/AOT.942252
28 Mar 2024 : Original article
Association Between FEV₁ Decline Rate and Mortality in Long-Term Follow-Up of a 21-Patient Pilot Clinical T...Ann Transplant In Press; DOI: 10.12659/AOT.942823
02 Apr 2024 : Original article
Liver Transplantation from Brain-Dead Donors with Hepatitis B or C in South Korea: A 2014-2020 Korean Organ...Ann Transplant In Press; DOI: 10.12659/AOT.943588
Most Viewed Current Articles
05 Apr 2022 : Original article
Impact of Statins on Hepatocellular Carcinoma Recurrence After Living-Donor Liver TransplantationDOI :10.12659/AOT.935604
Ann Transplant 2022; 27:e935604
12 Jan 2022 : Original article
Risk Factors for Developing BK Virus-Associated Nephropathy: A Single-Center Retrospective Cohort Study of ...DOI :10.12659/AOT.934738
Ann Transplant 2022; 27:e934738
22 Nov 2022 : Original article
Long-Term Effects of Everolimus-Facilitated Tacrolimus Reduction in Living-Donor Liver Transplant Recipient...DOI :10.12659/AOT.937988
Ann Transplant 2022; 27:e937988
15 Mar 2022 : Case report
Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...DOI :10.12659/AOT.935860
Ann Transplant 2022; 27:e935860