Inflammation in areas of tubular atrophy in kidney allograft biopsies: A potent predictor of allograft failure

R. B. Mannon, A. J. Matas, J. Grande, R. Leduc, J. Connett, B. Kasiske, J. M. Cecka, R. S. Gaston, F. Cosio, S. Gourishankar, P. F. Halloran, L. Hunsicker, D. Rush

Research output: Contribution to journalArticle

130 Scopus citations

Abstract

The Banff scoring schema provides a common ground to analyze kidney transplant biopsies. Interstitial inflammation (i) and tubulitis (t) in areas of viable tissue are features in scoring acute rejection, but are excluded in areas of tubular atrophy (TA). We studied inflammation and tubulitis in a cohort of kidney transplant recipients undergoing allograft biopsy for new-onset late graft dysfunction (N = 337). We found inflammation ('iatr') and tubulitis ('tatr') in regions of fibrosis and atrophy to be strongly correlated with each other (p < 0.0001). Moreover, iatr was strongly associated with death-censored graft failure when compared to recipients whose biopsies had no inflammation, even after adjusting for the presence of interstitial fibrosis (Hazard Ratio = 2.31, [1.10-4.83]; p = 0.0262) or TA (hazard ratio = 2.42, [1.16-5.08]; p = 0.191), serum creatinine at the time of biopsy, time to biopsy and i score. Further, these results did not qualitatively change after additional adjustments for C4d staining or donor specific antibody. Stepwise regression identified the most significant markers of graft failure which include iatr score. We propose that a more global assessment of inflammation in kidney allograft biopsies to include inflammation in atrophic areas may provide better prognostic information. Phenotypic characterization of these inflammatory cells and appropriate treatment may ameliorate late allograft failure.

Original languageEnglish (US)
Pages (from-to)2066-2073
Number of pages8
JournalAmerican Journal of Transplantation
Volume10
Issue number9
DOIs
StatePublished - Sep 2010

Keywords

  • Banff schema
  • biopsy
  • fibrosis
  • graft failure
  • inflammation
  • injury

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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    Mannon, R. B., Matas, A. J., Grande, J., Leduc, R., Connett, J., Kasiske, B., Cecka, J. M., Gaston, R. S., Cosio, F., Gourishankar, S., Halloran, P. F., Hunsicker, L., & Rush, D. (2010). Inflammation in areas of tubular atrophy in kidney allograft biopsies: A potent predictor of allograft failure. American Journal of Transplantation, 10(9), 2066-2073. https://doi.org/10.1111/j.1600-6143.2010.03240.x