Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy

Background: Immunoglobulin A nephropathy (IgAN) is the most frequent recurrent disease in kidney transplant recipients and its recurrence contributes to reducing graft survival. Several variables at the time of recurrence have been associated with a higher risk of graft loss. The presence of clinica...

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Autores: Rodrigo Calabia, Emilio, Quintana, Luis, Vázquez Sánchez, Teresa, Sánchez Fructuoso, Ana, Buxeda, Anna, Gavela, Eva, Cazorla, Juan M., Cabello, Sheila, Beneyto, Maria Isabel, López-Oliva, Maria O., Diekmann, Fritz, Gómez Ortega, José M., Calvo Romero, Natividad, Pérez-Sáez, María José, Sancho, Asunción, Mazuecos, Auxiliadora, Espí Reig, Jordi, Jiménez, Carlos, Hernández, Domingo
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/61359
Acceso en línea:http://hdl.handle.net/10230/61359
http://dx.doi.org/10.1093/ckj/sfad259
Access Level:acceso abierto
Palabra clave:IgA nephropathy
Graft loss
Inflammation
Kidney transplantation
Recurrence
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spelling Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathyRodrigo Calabia, EmilioQuintana, LuisVázquez Sánchez, TeresaSánchez Fructuoso, AnaBuxeda, AnnaGavela, EvaCazorla, Juan M.Cabello, SheilaBeneyto, Maria IsabelLópez-Oliva, Maria O.Diekmann, FritzGómez Ortega, José M.Calvo Romero, NatividadPérez-Sáez, María JoséSancho, AsunciónMazuecos, AuxiliadoraEspí Reig, JordiJiménez, CarlosHernández, DomingoIgA nephropathyGraft lossInflammationKidney transplantationRecurrenceBackground: Immunoglobulin A nephropathy (IgAN) is the most frequent recurrent disease in kidney transplant recipients and its recurrence contributes to reducing graft survival. Several variables at the time of recurrence have been associated with a higher risk of graft loss. The presence of clinical or subclinical inflammation has been associated with a higher risk of kidney graft loss, but it is not precisely known how it influences the outcome of patients with recurrent IgAN. Methods: We performed a multicentre retrospective study including kidney transplant recipients with biopsy-proven recurrence of IgAN in which Banff and Oxford classification scores were available. 'Tubulo-interstitial inflammation' (TII) was defined when 't' or 'i' were ≥2. The main endpoint was progression to chronic kidney disease (CKD) stage 5 or to death censored-graft loss (CKD5/DCGL). Results: A total of 119 kidney transplant recipients with IgAN recurrence were included and 23 of them showed TII. Median follow-up was 102.9 months and 39 (32.8%) patients reached CKD5/DCGL. TII related to a higher risk of CKD5/DCGL (3 years 18.0% vs 45.3%, log-rank 7.588, P = .006). After multivariate analysis, TII remained related to the risk of CKD5/DCGL (HR 2.344, 95% CI 1.119-4.910, P = .024) independently of other histologic and clinical variables. Conclusions: In kidney transplant recipients with IgAN recurrence, TII contributes to increasing the risk of CKD5/DCGL independently of previously well-known variables. We suggest adding TII along with the Oxford classification to the clinical variables to identify recurrent IgAN patients at increased risk of graft loss who might benefit from intensified immunosuppression or specific IgAN therapies.Oxford University Press202420242023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/61359http://dx.doi.org/10.1093/ckj/sfad259reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésClin Kidney J. 2023 Oct 16;17(1):sfad259© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.comhttp://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/613592026-06-12T07:21:37Z
dc.title.none.fl_str_mv Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy
title Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy
spellingShingle Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy
Rodrigo Calabia, Emilio
IgA nephropathy
Graft loss
Inflammation
Kidney transplantation
Recurrence
title_short Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy
title_full Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy
title_fullStr Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy
title_full_unstemmed Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy
title_sort Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy
dc.creator.none.fl_str_mv Rodrigo Calabia, Emilio
Quintana, Luis
Vázquez Sánchez, Teresa
Sánchez Fructuoso, Ana
Buxeda, Anna
Gavela, Eva
Cazorla, Juan M.
Cabello, Sheila
Beneyto, Maria Isabel
López-Oliva, Maria O.
Diekmann, Fritz
Gómez Ortega, José M.
Calvo Romero, Natividad
Pérez-Sáez, María José
Sancho, Asunción
Mazuecos, Auxiliadora
Espí Reig, Jordi
Jiménez, Carlos
Hernández, Domingo
author Rodrigo Calabia, Emilio
author_facet Rodrigo Calabia, Emilio
Quintana, Luis
Vázquez Sánchez, Teresa
Sánchez Fructuoso, Ana
Buxeda, Anna
Gavela, Eva
Cazorla, Juan M.
Cabello, Sheila
Beneyto, Maria Isabel
López-Oliva, Maria O.
Diekmann, Fritz
Gómez Ortega, José M.
Calvo Romero, Natividad
Pérez-Sáez, María José
Sancho, Asunción
Mazuecos, Auxiliadora
Espí Reig, Jordi
Jiménez, Carlos
Hernández, Domingo
author_role author
author2 Quintana, Luis
Vázquez Sánchez, Teresa
Sánchez Fructuoso, Ana
Buxeda, Anna
Gavela, Eva
Cazorla, Juan M.
Cabello, Sheila
Beneyto, Maria Isabel
López-Oliva, Maria O.
Diekmann, Fritz
Gómez Ortega, José M.
Calvo Romero, Natividad
Pérez-Sáez, María José
Sancho, Asunción
Mazuecos, Auxiliadora
Espí Reig, Jordi
Jiménez, Carlos
Hernández, Domingo
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv IgA nephropathy
Graft loss
Inflammation
Kidney transplantation
Recurrence
topic IgA nephropathy
Graft loss
Inflammation
Kidney transplantation
Recurrence
description Background: Immunoglobulin A nephropathy (IgAN) is the most frequent recurrent disease in kidney transplant recipients and its recurrence contributes to reducing graft survival. Several variables at the time of recurrence have been associated with a higher risk of graft loss. The presence of clinical or subclinical inflammation has been associated with a higher risk of kidney graft loss, but it is not precisely known how it influences the outcome of patients with recurrent IgAN. Methods: We performed a multicentre retrospective study including kidney transplant recipients with biopsy-proven recurrence of IgAN in which Banff and Oxford classification scores were available. 'Tubulo-interstitial inflammation' (TII) was defined when 't' or 'i' were ≥2. The main endpoint was progression to chronic kidney disease (CKD) stage 5 or to death censored-graft loss (CKD5/DCGL). Results: A total of 119 kidney transplant recipients with IgAN recurrence were included and 23 of them showed TII. Median follow-up was 102.9 months and 39 (32.8%) patients reached CKD5/DCGL. TII related to a higher risk of CKD5/DCGL (3 years 18.0% vs 45.3%, log-rank 7.588, P = .006). After multivariate analysis, TII remained related to the risk of CKD5/DCGL (HR 2.344, 95% CI 1.119-4.910, P = .024) independently of other histologic and clinical variables. Conclusions: In kidney transplant recipients with IgAN recurrence, TII contributes to increasing the risk of CKD5/DCGL independently of previously well-known variables. We suggest adding TII along with the Oxford classification to the clinical variables to identify recurrent IgAN patients at increased risk of graft loss who might benefit from intensified immunosuppression or specific IgAN therapies.
publishDate 2023
dc.date.none.fl_str_mv 2023
2024
2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/61359
http://dx.doi.org/10.1093/ckj/sfad259
url http://hdl.handle.net/10230/61359
http://dx.doi.org/10.1093/ckj/sfad259
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Clin Kidney J. 2023 Oct 16;17(1):sfad259
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by-nc/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Oxford University Press
publisher.none.fl_str_mv Oxford University Press
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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