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Predictors of Kidney Transplant Failure Identified

Those with scarring and inflammation one year after transplant are at higher risk of failure

FRIDAY, Sept. 3 (HealthDay News) -- Kidney transplant recipients with interstitial fibrosis and subclinical inflammation after one year are at an increased risk of transplant failure, according to a study published online Sept. 2 in the Journal of the American Society of Nephrology.

Walter D. Park, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues evaluated 151 living-donor, tacrolimus/mycophenolate-treated recipients who did not have overt risk factors for reduced graft survival.

The researchers found that the 86 recipients with transplants that had normal histology and the 45 with fibrosis alone on one-year protocol biopsy had stable renal function between one and five years; however, the 20 recipients with transplants that had both fibrosis and inflammation exhibited a decline in glomerular filtration rate and reduced graft survival. Immunohistochemistry confirmed the presence of higher levels of interstitial T cells and macrophages/dendritic cells among those with both fibrosis and inflammation. These recipients also experienced increased expression of transcripts related to innate and cognate immunity. In addition, microarray profiles showed that, among the overexpressed transcripts, potentially damaging immunologic activities were enriched.

"Therefore, the combination of fibrosis and inflammation in one-year protocol biopsies associates with reduced graft function and survival as well as a rejection-like gene expression signature, even among recipients with no clinical risk factors for poor outcomes," the authors write. "Early interventions aimed at altering rejection-like inflammation may improve long-term survival of kidney allografts."

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