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Distinct patient profiles are associated with differing allograft survival outcomes after kidney transplant
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Researchers of a published study identified five distinct archetypes of patients with transplant glomerulopathy, each of which were linked to different allograft survival outcomes.
“Most studies have consistently shown a strong association of transplant glomerulopathy with poor allograft outcomes; however, no previous report has addressed, in a large and appropriately annotated and followed multicenter population, potential distinct survival profiles of transplant glomerulopathy patients with different underlying pathogeneses,” Olivier Aubert, MD, PhD, of the Paris Translational Research Center for Organ Transplantation, and colleagues wrote.
To characterize the heterogeneity among patients with transplant glomerulopathy and to potentially help clinicians determine which patients are at high risk for allograft failure, researchers identified 385 patients who underwent kidney transplant and who presented with a diagnosis of transplant glomerulopathy based on biopsies performed from January 2004 through December 2014 (552 biopsies; median time from transplant to transplant glomerulopathy diagnosis, 33.18 months). Researchers classified patients into five distinct groups by using an unsupervised archetype analysis of comprehensive pathology findings and clinical, immunological and outcome data.
After transplant glomerulopathy diagnosis, kidney allograft survival rates were 69.4%, 57.1%, 43.3% and 25.5% at 3, 5, 7 and 10 years, respectively.
Researchers found that each of the five patient-archetypes demonstrated different allograft survival profiles. When archetype 1 was used as the reference (allograft survival at 3 years post-transplant glomerulopathy biopsy, 92%; at 5 years, 88%), researchers observed a gradually decreasing allograft survival rate at 3 and 5 years after transplant glomerulopathy biopsy in patients from archetype 3 (72% and 58%; HR = 2.16), archetype 5 (77% and 57%; HR = 2.39) archetype 2 (54% and 46%; HR = 2.92) and archetype 4 (36% and 22%; HR = 6.13).
Finally, researchers examined allograft survival in relation to treatment of transplant glomerulopathy lesion and found that, for archetype 2, allograft survival at 5 years was 27.9% for untreated patients vs. 64.6% for treated patients.
“This study responds to a current challenge in transplant medicine, highlighted by regulatory agencies and international societies, to establish and refine diagnostic standards and improve risk stratification in renal transplantation,” the researchers wrote. “A probabilistic data-driven archetypal approach applied to a large well-annotated multicentric cohort of kidney biopsies with transplant glomerulopathy refines the diagnostic and prognostic features associated with transplant glomerulopathy and reduces heterogeneity, thereby improving transplant glomerulopathy characterization and risk stratification in the individual patient.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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