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Title: | Defining causes of death-censored kidney allograft failure: A 5-year multicentre ANZDATA and clinical cross-sectional study. | Authors: | Mulley W.R.;Hughes P.D.;Collins M.G.;Pilmore H.L.;Clayton P.A.;Wyld M.L.;Lee D.;van der Jeugd J.;Fernando S.C.;Kuo S.F.-T.;Tan S.;Jahan S.;Lim W.H. | Monash Health Department(s): | Nephrology Centre for Inflammatory Diseases at Monash Health |
Institution: | (Mulley, Fernando) Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia (Mulley, Fernando) Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, VIC, Australia (Hughes, Kuo) Department of Nephrology, The Royal Melbourne Hospital, Parkville, VIC, Australia (Hughes, Kuo) Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia (Collins, Pilmore) Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand (Collins, Clayton, Jahan) Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia (Collins, Clayton) Adelaide Medical School, University of Adelaide, Adelaide, Australia (Pilmore) Department of Medicine, University of Auckland, Auckland, New Zealand (Clayton) Australia & New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, Australia (Wyld) Department of Renal and Transplant Medicine, Westmead Hospital, Westmead, NSW, Australia (Wyld) School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia (Lee) Department of Renal Medicine, Eastern Health, Box Hill, VIC, Australia (Lee) Eastern Health Clinical School, Monash University, Clayton, VIC, Australia (Lee) Department of Nephrology, Austin Health, Heidelberg, VIC, Australia (van der Jeugd, Tan) Department of Nephrology, Flinders Medical Centre, Adelaide, Australia (Lim) Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia (Lim) Medical School, University of Western Australia, Perth, Australia |
Issue Date: | 7-Oct-2024 | Copyright year: | 2024 | Publisher: | John Wiley and Sons Inc | Place of publication: | Australia | Publication information: | Nephrology. (no pagination), 2024. Date of Publication: 2024. | Journal: | Nephrology | Abstract: | Aim: Determining specific causes of allograft failure allows a focus on understanding and treating these conditions. Previous studies highlight chronic antibody-mediated rejection as a leading cause of late allograft failure. We sought to define causes of allograft failure in a large cohort of kidney transplant recipients across multiple centres in Australia and New Zealand, including cases previously attributed to chronic allograft nephropathy (CAN). Method(s): All death-censored allograft failures at 9 participating centres between 1 January 2014 to 31 December 2018 were included. Available clinical and biopsy data were reviewed and the "most likely" cause assigned. Result(s): There were 642 death-censored allograft failures in the study period. Of these, 495 (77.1%) had an informative biopsy performed a median of 13.4 months (IQR 2.5-39.1 months) prior to allograft failure. Rejection of any type was the leading cause of allograft failure (47.5%), comprised chiefly of chronic antibody-mediated rejection (37.4%) and chronic T-cell mediated rejection (6.4%). Other leading causes were undifferentiated interstitial fibrosis and tubular atrophy (10.8%), late medical and surgical complications (8.1%) and recurrent or de novo glomerulonephritis (7.0%). Polyoma viral nephropathy and calcineurin inhibitor toxicity each contributed to <2%. Causes of allograft failure previously attributed to CAN (n = 419, 65.3%) had a similar distribution to the overall cohort, with 43.9% attributed to chronic antibody-mediated rejection. Conclusion(s): To prolong allograft survival, improved strategies are needed to curtail alloimmune responses. Greater understanding of the causes of undifferentiated interstitial fibrosis and tubular atrophy and potential treatments would also be of considerable benefit.Copyright © 2024 The Author(s). Nephrology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Nephrology. | DOI: | http://monash.idm.oclc.org/login?url=https://dx.doi.org/10.1111/nep.14397 | PubMed URL: | 39349052 [https://www.ncbi.nlm.nih.gov/pubmed/?term=39349052] | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/52595 | Type: | Article | Subjects: | allograft antibody mediated rejection chronic allograft nephropathy glomerulonephritis kidney allograft kidney disease kidney graft kidney transplantation |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional, or survey) |
Appears in Collections: | Articles |
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