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. 2019 May;19(5):1432-1443.
doi: 10.1111/ajt.15204. Epub 2019 Jan 24.

Long-term follow-up of the DeKAF cross-sectional cohort study

Arthur J Matas  1 , Ann Fieberg  2 , Roslyn B Mannon  3 , Robert Leduc  2 , Joe Grande  4 , Bertram L Kasiske  5 , Michael Cecka  6 , Robert Gaston  3 , Lawrence Hunsicker  7 , John Connett  2 , Fernando Cosio  4 , Sita Gourishankar  8 , David Rush  9
Affiliations

Long-term follow-up of the DeKAF cross-sectional cohort study

Arthur J Matas et al. Am J Transplant. 2019 May.

Abstract

The DeKAF study was developed to better understand the causes of late allograft loss. Preliminary findings from the DeKAF cross-sectional cohort (with follow-up < 20 months) have been published. Herein, we present long-term outcomes in those recipients (mean follow-up ± SD, 6.6 ± 0.7 years). Eligibility included being transplanted prior to October 1, 2005; serum creatinine ≤ 2.0 mg/dL on January 1, 2006; and subsequently developing new-onset graft dysfunction leading to a biopsy. Mean time from transplant to biopsy was 7.5 ± 6.1 years. Histologic findings and DSA were studied in relation to postbiopsy outcomes. Long-term follow-up confirms and expands the preliminary results of each of 3 studies: (1) increasing inflammation in area of atrophy (irrespective of inflammation in nonscarred areas [Banff i]) was associated with increasingly worse postbiopsy death-censored graft survival; (2) hierarchical analysis based on Banff scores defined clusters (entities) that differed in long-term death-censored graft survival; and (3) C4d-/DSA- recipients had significantly better (and C4d+/DSA+ worse) death-censored graft survival than other groups. C4d+/DSA- and C4d-/DSA+ had similar intermediate death-censored graft survival. Clinical and histologic findings at the time of new-onset graft dysfunction define high- vs low-risk groups for long-term death-censored graft survival, even years posttransplant. These findings can help differentiate groups for potential intervention studies.

Keywords: antibody biology; chronic allograft nephropathy; classification systems: Banff classification; clinical research/practice; clinical trial; graft survival; kidney transplantation/nephrology.

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Figures

FIGURE 1
FIGURE 1
Years from biopsy to graft failure by iatr scoring: extended follow-up
FIGURE 2
FIGURE 2
Years from biopsy to graft failure by iatr and i scoring: extended follow-up
FIGURE 3
FIGURE 3
Original clusters based on Banff i, g, ct, cv, ah, mm, plus tatr (data shown for the 6 larger clusters N = 240). Only scores used in clustering are shown
FIGURE 4
FIGURE 4
Years from biopsy to graft failure by cluster: extended follow-up
FIGURE 5
FIGURE 5
Years from biopsy to graft failure by C4d and DSA: extended follow-up
See this image and copyright information in PMC

References

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