Fiche publication
Date publication
juillet 2015
Journal
Journal of the American Society of Nephrology : JASN
Auteurs
Membres identifiés du Cancéropôle Est :
Dr VERNEREY Dewi
Tous les auteurs :
Loupy A, Vernerey D, Tinel C, Aubert O, Duong van Huyen JP, Rabant M, Verine J, Nochy D, Empana JP, Martinez F, Glotz D, Jouven X, Legendre C, Lefaucheur C
Lien Pubmed
Résumé
Kidney allograft rejection can occur in clinically stable patients, but long-term significance is unknown. We determined whether early recognition of subclinical rejection has long-term consequences for kidney allograft survival in an observational prospective cohort study of 1307 consecutive nonselected patients who underwent ABO-compatible, complement-dependent cytotoxicity-negative crossmatch kidney transplantation in Paris (2000-2010). Participants underwent prospective screening biopsies at 1 year post-transplant, with concurrent evaluations of graft complement deposition and circulating anti-HLA antibodies. The main analysis included 1001 patients. Three distinct groups of patients were identified at the 1-year screening: 727 (73%) patients without rejection, 132 (13%) patients with subclinical T cell-mediated rejection (TCMR), and 142 (14%) patients with subclinical antibody-mediated rejection (ABMR). Patients with subclinical ABMR had the poorest graft survival at 8 years post-transplant (56%) compared with subclinical TCMR (88%) and nonrejection (90%) groups (P<0.001). In a multivariate Cox model, subclinical ABMR at 1 year was independently associated with a 3.5-fold increase in graft loss (95% confidence interval, 2.1 to 5.7) along with eGFR and proteinuria (P<0.001). Subclinical ABMR was associated with more rapid progression to transplant glomerulopathy. Of patients with subclinical TCMR at 1 year, only those who further developed de novo donor-specific antibodies and transplant glomerulopathy showed higher risk of graft loss compared with patients without rejection. Our findings suggest that subclinical TCMR and subclinical ABMR have distinct effects on long-term graft loss. Subclinical ABMR detected at the 1-year screening biopsy carries a prognostic value independent of initial donor-specific antibody status, previous immunologic events, current eGFR, and proteinuria.
Mots clés
Adult, Age Distribution, Allografts, immunology, Antibodies, immunology, Biopsy, Needle, Cohort Studies, Delayed Graft Function, epidemiology, Female, France, Glomerular Filtration Rate, Graft Rejection, epidemiology, Humans, Immunohistochemistry, Incidence, Kaplan-Meier Estimate, Kidney Transplantation, adverse effects, Male, Middle Aged, Multivariate Analysis, Phenotype, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Assessment, Severity of Illness Index, Sex Distribution, Survival Rate, T-Lymphocytes, immunology, Time Factors, Transplant Recipients, statistics & numerical data
Référence
J. Am. Soc. Nephrol.. 2015 Jul;26(7):1721-31
