Cohort study of the prognostic significance of acute transplant glomerulitis in acutely rejecting renal allografts

Background. Acute transplant glomerulitis is a unique lesion in renal allog rafts, the prognostic significance of which is controversial. We conducted this retrospective cohort study to examine the independent prognostic signi ficance of moderate-to-severe transplant glomerulitis in acute rejection. Methods. Renal allograft survival for patients with acute rejection were st udied, comparing one group with significant glomerulitis (G, n=28) with tho se with no glomerulitis (NG, n=35). Clinical, biopsy, and demographic data and renal graft survival were compared, and the association of G with graft failure was examined. Results. In the G versus NG group, a greater percentage of patients were hi ghly sensitized (peak panel reactive antibody value > 80%; P=0.009), had ha d a previous renal transplant (40% vs. 11%; P=0.02), or had suffered from d elayed graft function (P=0.03). The G group had a trend toward earlier reje ction episodes (P=0.07), a significantly higher serum creatinine at the tim e of index biopsy (P=0.01), a higher prevalence of vascular rejection (P=0. 02), and less improvement in mean reciprocal serum creatinine at 1-2 weeks after biopsy (P=0.02). Although there was a trend toward shorter allograft survival in the G group (P=0.09), the level of significance of which increa sed with adjustment for transplantation time period and the duration of the transplant-biopsy interval (P=0.06), the relative risk for graft loss was no longer significant when additionally adjusted for index biopsy Banff sco re (relative risk, 0.97; P=0.97). Conclusion. In this study, G was significantly more common in highly sensit ized patients and was strongly associated with vascular rejection biopsies but was not an independent predictor of graft survival.