Published online Oct 28, 2019. doi: 10.5500/wjt.v9.i6.123
Peer-review started: June 9, 2019
First decision: August 2, 2019
Revised: September 17, 2019
Accepted: October 2, 2019
Article in press: October 2, 2019
Published online: October 28, 2019
The histopathological findings on the failing kidney allograft in the modern era is not well studied. In this study, we present our experience working with kidney transplant recipients with graft failure within one year of the biopsy.
To report the histopathological characteristics of failed kidney allografts in the current era of immunosuppression based on the time after transplant, cause of the end-stage renal disease and induction immunosuppressive medications.
In a single-center observational study, we characterized the histopathological findings of allograft biopsies in kidney transplant recipients with graft failure within one year after the biopsy.
We identified 329 patients with graft failure that met the selection criteria between January 1, 2006 and December 31, 2016. The three most common biopsy findings were interstitial fibrosis and tubular atrophy (IFTA, 53%), acute rejection (AR, 43%) and transplant glomerulopathy (TG, 33%). Similarly, the three most common causes of graft failure based on the primary diagnosis were AR (40%), TG (17%), and IFTA (13%). Most grafts failed within two years of post-transplant (36%). Subsequently, approximately 10%-15% of grafts failed every two years: > 2-4 years (16%), > 4-6 years (13%), > 6-8 years (11%), > 8-10 years (9%) and > 10 years (16%). AR was the most common cause of graft failure in the first six years (48%), whereas TG was the most prevalent cause of graft failure after 6 years (32%) of transplant.
In the current era of immunosuppression, AR is still the most common cause of early graft failure, while TG is the most prevalent cause of late graft failure.
Core tip: There have been significant improvements in early graft survival. However, long-term graft survival has only had modest improvement. Causes of “true” late kidney allograft failure remain unclear. In this study, we explored the causes of graft failure based on the various factors, which may allow providers to determine interventions to prevent poor outcomes. We found, acute rejection, mainly antibody-mediated rejection, was the most common cause of early graft failure. And transplant glomerulopathy was a common cause of late graft failure, which occurred mainly after 6-7 years post-transplant even surpassed acute rejection.