BMI and Early Morphological Fibrosis Biomarkers are Important Predictive Factors for Long-Term Kidney Graft Outcome

Kidney transplant (KT) survival depends on various immunological and non-immunological factors. The aim of the study was to evaluate impact of clinical and morphological parameters on long-term kidney graft survival in overweight and normal weight patients.

A retrospective study included 124 KT patients (pts) whose serial biopsies could be evaluated (KT biopsies at 0 or 3 months, and 1 year), and data on the following clinical parameters were collected: renal function (eGFR), acute rejections (AR), number of anti-hypertensive drugs, donor age and body mass index (BMI). Pts were divided into 2 groups according to BMI (BMI < 25 lt; 25 vs BMI ≥ 25). KT and the patient's long-term (10 years) survival was calculated. Morphological factors included the presence of tubulointerstitial fibrosis (TIF) and glomerulosclerosis (GS) and the results of immunohistochemical (collagen-3, Col 3, TGF-β) studies.

The long-term results of KT were influenced by donor age (HR = 0.9, p < .05), 3-mo BMI (HR = 1.69; p < .05), 1-year HT drugs (HR = 3.92, p < .05) and Col 3 (HR = 12.62, p < .05). Pts 10-year survival was influenced by 1-year BMI (HR = 2.53, p < .05), Col 3 accumulation (HR = 91.26, p < .05).

Our study revealed predictive factors for long-term outcome were donor age, amount of 1-year antihypertensive medications and Col 3 accumulation, also excess bodyweight had a negative impact on the pts and allograft survival. Col 3, especially Δ Col 3, is a promising long-term predictive morphological parameter.