Ouellet Gabriel, Houde Isabelle, Riopel Julie, Latulippe Eva, Douville Pierre, Lesage Julie, Côté Isabelle, Lapointe Isabelle, De Serres Sacha A
Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
Department of Laboratory Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.
Transplant Direct. 2022 Nov 4;8(12):e1375. doi: 10.1097/TXD.0000000000001375. eCollection 2022 Dec.
Interstitial fibrosis and tubular atrophy (IFTA) found on 1-y surveillance biopsies has been associated with poor graft outcomes. However, its progression over time and relationship to outcomes are less well defined.
We studied implantation and 6-mo surveillance biopsies and examined the association between the progression of IFTA (ΔIFTA) and a composite of censored graft loss or doubling of serum creatinine in 248 adult kidney recipients.
The percentage of patients with ΔIFTA of 1 or ≥2 was 35% and 22%, respectively. Positive ΔIFTA was a risk factor for the composite endpoint (hazard ratio, 1.36; 95% confidence interval, 1.03-1.79). This estimate was robust to adjustment for recipient and donor baseline characteristics, baseline IFTA, tacrolimus levels, and rejection status. ΔIFTA was associated with decreased estimated glomerular filtration rate at 3 and 5 y. IFTA+i was a predictor in the cohort; however, IFTA progression was not limited to those with a mononuclear cell interstitial inflammation (Banff "i") score above zero. Notably, donor age was a predictor of IFTA at 6 mo, but not of ΔIFTA, whereas rejection, donor diabetes, and recipient smoking status were.
Progression of IFTA at 6 mo can predict outcomes. ΔIFTA was not related to donor age but may be linked to other risk factors influencing decision-making for donor versus recipient selection.
在1年监测活检中发现的间质纤维化和肾小管萎缩（IFTA）与移植肾预后不良相关。然而，其随时间的进展以及与预后的关系尚不清楚。
我们研究了植入时和6个月监测活检，并在248例成年肾移植受者中检查了IFTA进展（ΔIFTA）与审查的移植肾丢失或血清肌酐翻倍的综合指标之间的关联。
ΔIFTA为1或≥2的患者百分比分别为35%和22%。阳性ΔIFTA是综合终点的危险因素（风险比，1.36；95%置信区间，1.03 - 1.79）。该估计值在对受者和供者基线特征、基线IFTA、他克莫司水平和排斥状态进行调整后仍然稳健。ΔIFTA与3年和5年时估计的肾小球滤过率降低相关。IFTA+i是该队列中的一个预测指标；然而，IFTA进展并不局限于单核细胞间质炎症（Banff“i”）评分高于零的患者。值得注意的是，供者年龄是6个月时IFTA的预测指标，但不是ΔIFTA的预测指标，而排斥反应、供者糖尿病和受者吸烟状态是ΔIFTA的预测指标。
6个月时IFTA的进展可以预测预后。ΔIFTA与供者年龄无关，但可能与影响供者与受者选择决策的其他危险因素有关。
