Histopathologic Clusters Differentiate Subgroups Within the Nonspecific Diagnoses of CAN or CR: Preliminary Data from the DeKAF Study

• Published in: American journal of transplantation Vol. 10; no. 2; pp. 315 - 323
• Main Authors: Matas, A. J., Leduc, R., Rush, D., Cecka, J. M., Connett, J., Fieberg, A., Halloran, P., Hunsicker, L., Cosio, F., Grande, J., Mannon, R., Gourishankar, S., Gaston, R., Kasiske, B.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.02.2010; Wiley
• Subjects: Allograft function; Biological and medical sciences; Biopsy; Cluster Analysis; Complement C4b; Creatinine - blood; Graft Survival; Humans; kidney transplantation; Medical sciences; Peptide Fragments; Renal Insufficiency - diagnosis; Renal Insufficiency - pathology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue Donors; Treatment Outcome; Homograft; Cluster; Subgroup; Data; Allograft function; Homotransplantation; Kidney; Anatomic pathology; Histopathology; Treatment; Urinary system; Surgery; Graft; Diagnosis; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2009.02943.x

The nonspecific diagnoses ‘chronic rejection’‘CAN’, or ‘IF/TA’ suggest neither identifiable pathophysiologic mechanisms nor possible treatments. As a first step to developing a more useful taxonomy for causes of new‐onset late kidney allograft dysfunction, we used cluster analysis of individual Banff score components to define subgroups. In this multicenter study, eligibility included being transplanted prior to October 1, 2005, having a ‘baseline’ serum creatinine ≤2.0 mg/dL before January 1, 2006, and subsequently developing deterioration of graft function leading to a biopsy. Mean time from transplant to biopsy was 7.5 ± 6.1 years. Of the 265 biopsies (all with blinded central pathology interpretation), 240 grouped into six large (n > 13) clusters. There were no major differences between clusters in recipient demographics. The actuarial postbiopsy graft survival varied by cluster (p = 0.002). CAN and CNI toxicity were common diagnoses in each cluster (and did not differentiate clusters). Similarly, C4d and presence of donor specific antibody were frequently observed across clusters. We conclude that for recipients with new‐onset late graft dysfunction, cluster analysis of Banff scores distinguishes meaningful subgroups with differing outcomes. Cluster analysis based on Banff score components distinguishes meaningful subgroups with differing outcomes.