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Different patient profiles are associated with different survival results of allogeneic grafts after a kidney transplant



Researchers from a published study identified five different archetypes of patients with glomerulopathy transplantation, each of which was linked to different survival results from allogeneic grafts..

"Most studies consistently have a strong association of transplant glomerulopathy with poor allotransplantation results; however, no previous report has discussed in a large and adequately annotated and monitored multicenter population potentially different survival profiles of patients with transplant glomerulopathy with different underlying pathogenesis " Olivier Aubert, MD, PhD, from the Paris Translational Research Center for organ transplantation, and colleagues wrote.

To characterize the heterogeneity of patients with transplant glomerulopathy and possibly help clinicians determine which patients are at high risk of allogeneic transplant failure, the researchers identified 385 patients who had undergone kidney transplantation and who presented a diagnosis of transplantation glomerulopathy based on biopsies performed from January 2004 up to and including December 2014 (552 biopsies; median time from transplant to glomerulopathy diagnosis, 33.18 months). Researchers classified patients into five different groups using an unchecked archetype analysis of extensive pathological findings and clinical, immunological and outcome data.

After transplant glomerulopathy diagnosis, survival of the allograft survival were 69.4%, 57.1%, 43.3% and 25.5% at 3, 5, 7 and 10 years respectively.

Researchers discovered that each of the five patient archetypes exhibited different survival profiles for allograft. When archetype 1 was used as a reference (graft survival after 3 years post-transplant glomerulopathy biopsy, 92%, after 5 years, 88%), researchers observed a gradually decreasing allograf survival at 3 and 5 years after biopsy of transplantation glomerulopathy in patients of 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 the allogeneic graft survival in relation to the treatment of transplant glomerulopathy lesion and found that, for archetype 2, the 5-year graft survival was 27.9% for untreated patients versus 64.6% for treated patients.

"This study meets a current challenge in transplantation medicine, emphasized by regulators and international societies, to establish and refine diagnostic standards and improve risk stratification in kidney transplantation," the researchers wrote. "A probabilistic data-driven archetypal approach applied to a large well-annotated multicentre cohort of renal biopsies with transplant glomerulopathy refines the diagnostic and prognostic characteristics associated with transplant glomerulopathy and reduces heterogeneity, thereby improving the characterization of transplant glomerulopathy and risk stratification in the individual patient "- by Melissa J. Webb

revelations: The authors do not report relevant financial information.


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