PMID- 12780663
OWN - NLM
STAT- MEDLINE
DCOM- 20031021
LR  - 20191107
IS  - 0902-0063 (Print)
IS  - 0902-0063 (Linking)
VI  - 17
IP  - 3
DP  - 2003 Jun
TI  - Chronic rejection with or without transplant vasculopathy.
PG  - 163-70
AB  - BACKGROUND: Chronic allograft nephropathy (CAN) is defined and graded in the 
      Banff '97 scheme by the severity of interstitial fibrosis and tubular atrophy. It 
      has been denoted that chronic rejection can be diagnosed if the typical vascular 
      lesions are seen, consisting of fibrointimal thickening. We observed several 
      patients who developed CAN without vascular changes or signs of cyclosporine 
      toxicity. Therefore, we assessed the risk factor profiles of CAN with and without 
      transplant vasculopathy. METHODS: A cohort of 654 cadaveric renal transplants 
      performed between 1983 and 1997 that functioned for more than 6 months was 
      studied. Fifty-four transplants had CAN defined by a significant decline in renal 
      function together with interstitial fibrosis and tubular atrophy without signs of 
      cyclosporine nephrotoxicity or recurrent disease. Using the Banff chronic 
      vascular (CV) score, 23 of 54 cases (43%) had a chronic vasculopathy score of 0 
      or 1 whereas 31 cases (57%) had a CV score of 2 or 3. Applying multivariate 
      logistic regression, predictor variables of the two groups were compared with 231 
      transplants with a stable function for at least 5 yr. RESULTS: Graft histology 
      was obtained at a mean of 2.4 and 2.9 yr after transplantation in the group with 
      or without vasculopathy, respectively. Acute rejection episodes (AREs) after 3 
      months post-transplantation were the strongest risk factor for both forms of CAN, 
      odds ratio (OR) 14.7 (6.0-36.0). CAN with vasculopathy was also associated with 
      transplants performed in the 1980s, OR 4.95 (1.65-14.9) and with creatinine 
      clearance at 6 months, OR 0.58 (0.44-0.75) per 10 mL/min increase. In contrast, 
      young recipient age, OR 0.69 (0.47-0.99) per 10-yr increase, and the presence of 
      panel reactive antibodies at the time of transplantation, OR 1.26 (1.08-1.47) per 
      10% increase, were independent risk factors for CAN without vasculopathy. 
      CONCLUSIONS: After exclusion of cyclosporine toxicity or recurrent disease CAN 
      occurred without moderate or severe transplant vasculopathy in 43% of the cases. 
      The correlation with young recipient age, sensitization and late ARE suggest an 
      immune pathogenesis, consistent with chronic rejection.
FAU - Sijpkens, Yvo W J
AU  - Sijpkens YW
AD  - Department of Nephrology, Leiden University Medical Center, Leiden, The 
      Netherlands. y.w.j.sijpkens@lumc.nl
FAU - Doxiadis, Ilias I N
AU  - Doxiadis II
FAU - van Kemenade, Folkert J
AU  - van Kemenade FJ
FAU - Zwinderman, Aeilko H
AU  - Zwinderman AH
FAU - de Fijter, Johan W
AU  - de Fijter JW
FAU - Claas, Frans H J
AU  - Claas FH
FAU - Bruijn, Jan A
AU  - Bruijn JA
FAU - Paul, Leendert C
AU  - Paul LC
LA  - eng
PT  - Journal Article
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
RN  - 83HN0GTJ6D (Cyclosporine)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Atrophy
MH  - Chronic Disease
MH  - Cohort Studies
MH  - Cyclosporine/toxicity
MH  - Fibrosis/pathology
MH  - *Graft Rejection/pathology
MH  - Graft Survival
MH  - Humans
MH  - Kidney Transplantation/immunology/*pathology
MH  - Kidney Tubules/pathology
MH  - Logistic Models
MH  - Risk Factors
MH  - Time Factors
MH  - Vascular Diseases/*pathology
EDAT- 2003/06/05 05:00
MHDA- 2003/10/22 05:00
CRDT- 2003/06/05 05:00
PHST- 2003/06/05 05:00 [pubmed]
PHST- 2003/10/22 05:00 [medline]
PHST- 2003/06/05 05:00 [entrez]
AID - 039 [pii]
AID - 10.1034/j.1399-0012.2003.00039.x [doi]
PST - ppublish
SO  - Clin Transplant. 2003 Jun;17(3):163-70. doi: 10.1034/j.1399-0012.2003.00039.x.