Early subclinical rejection as a risk factor for late chronic humoral rejection

Francesc Moreso, Marta Carrera, Montse Goma, Miguel Hueso, Joana Sellares, Jaume Martorell, Josep M. Grinyó, Daniel Serón

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75 Citations (Scopus)


BACKGROUND.: Subclinical rejection and interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsies are associated with outcome. We study the relationship between histologic lesions in early protocol biopsies and histologic diagnoses in late biopsies for cause. MATERIALS AND METHODS.: Renal transplants with a protocol biopsy performed within the first 6 months posttransplant between 1988 and 2006 were reviewed. Biopsies were evaluated according to Banff criteria, and C4d staining was available in biopsies for cause. RESULTS.: Of the 517 renal transplants with a protocol biopsy, 109 had a subsequent biopsy for cause which showed the following histological diagnoses: chronic humoral rejection (CHR) (n=44), IF/TA (n=42), recurrence of the primary disease (n=11), de novo glomerulonephritis (n=7), T-cell-mediated rejection (n=4), and polyoma virus nephropathy (n=1). The proportion of retransplants (15.9% vs. 2.3%, P=0.058) and the prevalence of subclinical rejection were higher in patients with CHR than in patients with IF/TA (52.3% vs. 28.6%, P=0.0253). Demographic donor and recipient characteristics and clinical data at the time of protocol biopsy were not different between groups. Logistic regression analysis showed that subclinical rejection (relative risk, 2.52; 95% confidence interval, 1.1-6.3; P=0.047) but not retransplantation (relative risk, 6.7; 95% confidence interval, 0.8-58.8; P=0.085) was associated with CHR. CONCLUSION.: Subclinical rejection in early protocol biopsies is associated with late appearance of CHR.
Original languageEnglish
Pages (from-to)41-46
Issue number1
Publication statusPublished - 15 Jan 2012


  • Interstitial fibrosis
  • Protocol biopsies
  • Renal transplantation
  • Subclinical rejection
  • Transplant glomerulopathy


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