Transplant glomerulopathy as a cause of late graft loss

Several pathophysiological processes contribute to chronic kidney transplan t rejection. Among the most distinctive Is transplant glomerulopathy, chara cterized by widening of the subendothelial space with accumulation of flocc ulent material and duplication of the basement membrane, The current study assessed the course of graft loss in patients with and without this form of Injury. Twenty-five patients with prominent transplant glomerulopathy were identified from biopsies performed at a single center during 4 years, Thes e patients were compared with control patients with a similar degree of ren al dysfunction in whom biopsies showed chronic rejection without transplant glomerulopathy. Patients with transplant glomerulopathy showed an increase d rate of graft loss after biopsy. Biopsies were performed longer after tra nsplantation in these patients, however, than In control patients with an e qual degree of graft dysfunction. Graft survival from the time of transplan tation was therefore not different between the two groups. Morphological st udies showed that transplant glomerulopathy was not associated with increas ed severity of chronic vascular injury characterized by arterial and arteri olar intimal thickening or hyalinosis. These findings show that transplant glomerulopathy may develop late after transplantation on and separately fro m chronic vascular rejection. The appearance of transplant glomerulopathy o n a biopsy specimen is followed by accelerated graft loss, (C) 2000 by the National Kidney Foundation, Inc.