Research On Survival And Prognosis-related Factors For Different Pathological Types Of Chronic Allograft Nephropathy

Objective:Chronic antibody-mediated rejection (CAMR) and chronic T-cell mediated rejection (CTMR) were two new categories introduced in the Banff2005. Current knowledge about the natural history, prognosis-related factors of CAMR and CTMR is limited. This study compared the survival and prognosis-related factors of CAMR, CTMR and other types of chronic allograft nephropathy (OT-CAN).Method:This study enrolled130transplant recipients with biopsy-proven CAN in Kidney Disease Center,1st Affiliated Hospital of College of Medicine, Zhejang University, China, between January,2004and July2012. They were classified into four groups:IF/TA, CAMR, CTMR and CNI. Their survival data was obtained via medical records and telephone follow up. All statistical analyses were carried out using SPSS20software package.Result:We diagnosed62IF/TA,27CAMR,30CTMR and10CNI. The median time from kidney transplantation to biopsies was56(2-209) months in IF/TA,92(44-200) months in CAMR,122(7-241) months in CTMR, and116(49-172) months in CNI. The eGFR (MDRD) at the time of biopsies was42±16ml/min·1.73m2,36±23ml/min·1.73m2,8±4ml/min·1.73m2, and46±10ml/min·1.73m2, separately. The median time from kidney transplantation to clinical diagnosis of CAN was55.5(5-209) months,86.0(9-200) months,25.5(3-126) months and116(49-172) months. Death-censored graft survival from transplantation was worse in CTMR compared with IF/TA (P=0.002), CAMR (P=0.027) and CNI (P=0.002). HLA mismatches and acute rejection were negatively correlated with the long-term survival of patients with CTMR and CAMR.Conclusion:Graft survival from transplantation may be worse in patients with CTMR and CAMR, and may be better in patients with CNI. HLA mismatches and acute rejection were risk factors for patients with CTMR and CAMR.