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Glomerular damage as a predictor of renal allograft loss
Moscoso-Solorzano, G; Câmara, N. O. S; Franco, M. F; Araújo, S; Ortega, F; Pacheco-Silva, A; Mastroianni-Kirsztajn, G.
  • Moscoso-Solorzano, G; Universidade Federal de São Paulo. Departamento de Medicina. Disciplina de Nefrologia. Setor de Glomerulopatias. São Paulo. BR
  • Câmara, N. O. S; Universidade Federal de São Paulo. Departamento de Medicina. Disciplina de Nefrologia. Laboratório de Imunologia Clínica e Experimental. São Paulo. BR
  • Franco, M. F; Universidade Federal de São Paulo. Departamento de Patologia. São Paulo. BR
  • Araújo, S; Universidade Federal de São Paulo. Departamento de Patologia. São Paulo. BR
  • Ortega, F; Hospital Universitario Central de Asturias. Servicio de Nefrología. Oviedo. ES
  • Pacheco-Silva, A; Universidade Federal de São Paulo. Departamento de Medicina. Disciplina de Nefrologia. Laboratório de Imunologia Clínica e Experimental. São Paulo. BR
  • Mastroianni-Kirsztajn, G; Universidade Federal de São Paulo. Departamento de Medicina. Disciplina de Nefrologia. Setor de Glomerulopatias. São Paulo. BR
Braz. j. med. biol. res ; 43(6): 557-564, June 2010. ilus, tab
Article in English | LILACS | ID: lil-548268
ABSTRACT
Interstitial fibrosis and tubular atrophy (IF/TA) are the most common cause of renal graft failure. Chronic transplant glomerulopathy (CTG) is present in approximately 1.5-3.0 percent of all renal grafts. We retrospectively studied the contribution of CTG and recurrent post-transplant glomerulopathies (RGN) to graft loss. We analyzed 123 patients with chronic renal allograft dysfunction and divided them into three groups CTG (N = 37), RGN (N = 21), and IF/TA (N = 65). Demographic data were analyzed and the variables related to graft function identified by statistical methods. CTG had a significantly lower allograft survival than IF/TA. In a multivariate analysis, protective factors for allograft outcomes were use of angiotensin-converting enzyme inhibitor (ACEI; hazard ratio (HR) = 0.12, P = 0.001), mycophenolate mofetil (MMF; HR = 0.17, P = 0.026), hepatitis C virus (HR = 7.29, P = 0.003), delayed graft function (HR = 5.32, P = 0.016), serum creatinine ≥1.5 mg/dL at the 1st year post-transplant (HR = 0.20, P = 0.011), and proteinuria ≥0.5 g/24 h at the 1st year post-transplant (HR = 0.14, P = 0.004). The presence of glomerular damage is a risk factor for allograft loss (HR = 4.55, P = 0.015). The presence of some degree of chronic glomerular damage in addition to the diagnosis of IF/TA was the most important risk factor associated with allograft loss since it could indicate chronic active antibody-mediated rejection. ACEI and MMF were associated with better outcomes, indicating that they might improve graft survival.
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Full text: Available Index: LILACS (Americas) Main subject: Kidney Transplantation / Graft Rejection / Kidney Glomerulus / Kidney Tubules Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Adult / Female / Humans / Male Language: English Journal: Braz. j. med. biol. res Journal subject: Biology / Medicine Year: 2010 Type: Article Affiliation country: Brazil / Spain Institution/Affiliation country: Hospital Universitario Central de Asturias/ES / Universidade Federal de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Kidney Transplantation / Graft Rejection / Kidney Glomerulus / Kidney Tubules Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Adult / Female / Humans / Male Language: English Journal: Braz. j. med. biol. res Journal subject: Biology / Medicine Year: 2010 Type: Article Affiliation country: Brazil / Spain Institution/Affiliation country: Hospital Universitario Central de Asturias/ES / Universidade Federal de São Paulo/BR