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Early interstitial macrophage infiltration with mild dysfunction is associated with subsequent kidney graft loss

Ernesto Paoletti1, Elisabetta Bussalino1, Diego Bellino1

  • 1Nephrology, Dialysis, and Transplantation, University of Genova, Ospedale Policlinico San Martino, Genova, Italy.

Clinical Transplantation
|April 30, 2019
PubMed

Insights

High macrophage infiltration (CD68+ grade 3) in kidney transplants predicts graft loss. This finding is independent of other clinical factors, highlighting its importance in patient outcomes.

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation Medicine

Background:

  • Macrophage infiltration in kidney allografts is linked to poor outcomes.
  • Clinical impact of macrophage infiltration in kidney transplant recipients (KTRs) requires further evaluation.

Purpose of the Study:

  • To prospectively assess the association between macrophage infiltration and kidney graft outcomes in KTRs.
  • To determine if CD68+ infiltration is an independent predictor of graft loss.

Main Methods:

  • 37 KTRs with mild kidney dysfunction or proteinuria underwent biopsy in the first post-transplant year.
  • Assessed Banff score, CD68+ macrophage count (immunohistochemistry), and de novo donor-specific antibodies (DSA).
  • Followed patients for graft survival over 6.2 ± 2.7 years.

Main Results:

  • 15 KTRs had grade 3 CD68+ infiltration; 47% developed de novo DSA.
  • Graft loss occurred in 17 KTRs (46%), with 12 from the grade 3 CD68+ group.
  • Grade 3 CD68+ infiltrate independently predicted graft loss (HR 5.41) and was associated with lower graft survival (P=0.0074).

Conclusions:

  • Significant macrophage infiltration (grade 3 CD68+) is a critical indicator of poor kidney allograft outcome.
  • CD68+ infiltration is an independent predictor of graft loss, underscoring its clinical significance.
  • Monitoring macrophage infiltration may improve management strategies for KTRs.
Keywords:
clinical outcomegraft biopsyinterstitial macrophage infiltrationkidney transplantation

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