TY - JOUR
T1 - Mesangial expansion at 5 years predicts death and death-censored graft loss after renal transplantation
AU - Kukla, Aleksandra
AU - Alexander, Mariam P.
AU - Turkevi-Nagy, Sandor
AU - Merzkani, Massini
AU - Park, Walter
AU - Smith, Byron
AU - Zhang, Pingchuan
AU - Benavides, Xiomara
AU - D'Costa, Matthew
AU - Morales Alvarez, Catalina
AU - Denic, Aleksandar
AU - Bentall, Andrew
AU - Kudva, Yogish C.
AU - Stegall, Mark
N1 - Funding Information:
This work was partially supported by the Renal Pathology Society's Research Collaborator Program (S T‐G). The content of this manuscript is the sole responsibility of the authors.
Publisher Copyright:
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2021/1
Y1 - 2021/1
N2 - 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/m2) 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.
AB - 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/m2) 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.
KW - diabetes
KW - graft survival
KW - kidney transplant
KW - mesangial expansion
KW - patient survival
UR - http://www.scopus.com/inward/record.url?scp=85096677396&partnerID=8YFLogxK
U2 - 10.1111/ctr.14147
DO - 10.1111/ctr.14147
M3 - Article
C2 - 33170556
AN - SCOPUS:85096677396
SN - 0902-0063
VL - 35
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 1
M1 - e14147
ER -