Journal of the American Society of Nephrology : JASN · 2021
Exploring the Complexity of Death-Censored Kidney Allograft Failure.
СтатьяНазвание и аннотация: Перевод в очереди
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Mayrdorfer Manuel, Liefeldt Lutz, Wu Kaiyin, Rudolph Birgit, Zhang Qiang, Friedersdorff Frank, Lachmann Nils, Schmidt Danilo, Osmanodja Bilgin, Naik Marcel G, Duettmann Wiebke, Halleck Fabian, Merkel Marina, Schrezenmeier Eva, Waiser Johannes, Duerr Michael, Budde Klemens
Аннотация
BACKGROUND: Few studies have thoroughly investigated the causes of kidney graft loss (GL), despite its importance.
METHODS: A novel approach assigns each persistent and relevant decline in renal function over the lifetime of a renal allograft to a standardized category, hypothesizing that singular or multiple events finally lead to GL. An adjudication committee of three physicians retrospectively evaluated indication biopsies, laboratory testing, and medical history of all 303 GLs among all 1642 recipients of transplants between January 1, 1997 and December 31, 2017 at a large university hospital to assign primary and/or secondary causes of GL.
RESULTS: In 51.2% of the patients, more than one cause contributed to GL. The most frequent primary or secondary causes leading to graft failure were intercurrent medical events in 36.3% of graft failures followed by T cell-mediated rejection (TCMR) in 34% and antibody-mediated rejection (ABMR) in 30.7%. In 77.9%, a primary cause could be attributed to GL, of which ABMR was most frequent (21.5%). Many causes for GL were identified, and predominant causes for GL varied over time.
CONCLUSIONS: GL is often multifactorial and more complex than previously thought.
METHODS: A novel approach assigns each persistent and relevant decline in renal function over the lifetime of a renal allograft to a standardized category, hypothesizing that singular or multiple events finally lead to GL. An adjudication committee of three physicians retrospectively evaluated indication biopsies, laboratory testing, and medical history of all 303 GLs among all 1642 recipients of transplants between January 1, 1997 and December 31, 2017 at a large university hospital to assign primary and/or secondary causes of GL.
RESULTS: In 51.2% of the patients, more than one cause contributed to GL. The most frequent primary or secondary causes leading to graft failure were intercurrent medical events in 36.3% of graft failures followed by T cell-mediated rejection (TCMR) in 34% and antibody-mediated rejection (ABMR) in 30.7%. In 77.9%, a primary cause could be attributed to GL, of which ABMR was most frequent (21.5%). Many causes for GL were identified, and predominant causes for GL varied over time.
CONCLUSIONS: GL is often multifactorial and more complex than previously thought.
Предметные рубрики MeSH
AdultAgedAllograftsCalcineurin InhibitorsCardio-Renal SyndromeDatabases, FactualDeathFemaleGraft RejectionGraft SurvivalHumansImmunity, CellularImmunity, HumoralImmunosuppressive AgentsKidney Failure, ChronicKidney TransplantationMaleMiddle AgedPolyomavirus InfectionsRecurrenceRetrospective StudiesSurvival RateT-LymphocytesThrombosisTime FactorsTumor Virus InfectionsDrug Monitoring