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Related Experiment Videos

Chronic rejection with or without transplant vasculopathy.

Yvo W J Sijpkens1, Ilias I N Doxiadis, Folkert J van Kemenade

  • 1Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands. y.w.j.sijpkens@lumc.nl

Clinical Transplantation
|June 5, 2003
PubMed
Summary

Chronic allograft nephropathy (CAN) can occur without significant transplant vasculopathy. Risk factors for CAN without vasculopathy include young recipient age and sensitization, suggesting an immune-mediated process.

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Area of Science:

  • Nephrology
  • Transplantation immunology
  • Pathology

Background:

  • Chronic allograft nephropathy (CAN) is diagnosed by interstitial fibrosis and tubular atrophy in the Banff '97 scheme.
  • Vascular lesions (fibrointimal thickening) are typically associated with chronic rejection.
  • This study investigated CAN in patients lacking typical vascular changes or signs of cyclosporine toxicity.

Purpose of the Study:

  • To assess risk factor profiles for chronic allograft nephropathy (CAN) with and without transplant vasculopathy.
  • To differentiate the predictors of CAN based on the presence or absence of chronic vascular changes.

Main Methods:

  • A cohort of 654 cadaveric renal transplants functioning >6 months was analyzed.
  • Fifty-four cases of CAN (without cyclosporine toxicity or recurrent disease) were identified.

Related Experiment Videos

  • Multivariate logistic regression compared predictor variables between CAN with (CV score 2-3) and without (CV score 0-1) vasculopathy against controls with stable function.

    • Main Results:

    • Acute rejection episodes after 3 months post-transplantation were the strongest risk factor for both forms of CAN (OR 14.7).
    • CAN with vasculopathy was linked to earlier transplants (1980s) and lower 6-month creatinine clearance.
    • CAN without vasculopathy was independently associated with younger recipient age (OR 0.69) and pre-transplant panel reactive antibodies (OR 1.26).

    Conclusions:

    • Nearly half (43%) of CAN cases occurred without moderate/severe transplant vasculopathy after excluding other causes.
    • The findings suggest an immune-mediated pathogenesis for CAN without vasculopathy.
    • Late acute rejection, young recipient age, and sensitization are key factors in immune-mediated CAN.