Incidence, Risk Factors, and Clinical Outcome of Transplant Glomerulopathy

Background: Transplant glomerulopathy (TG) is a histological manifestation of chronic antibody-mediated rejection. Aims & Objectives: This study aims to determine the incidence, risk factors, and clinical outcomes of TG. Materials and Methods: This retrospective study included renal allograft recipients who underwent graft biopsies over a seven-year period. Data were collected from electronic medical records. TG and non-TG groups were compared for the variables. Results: A total of 148 kidney transplant recipients underwent graft biopsies, both protocol and indication. Transplant glomerulopathy (TG) was identified in 16 (10.8%) of these biopsies; two cases were detected in protocol biopsies within the first year after transplantation. Among the 16 TG cases, one patient (6.2%) developed TG six months post-surgery, two (12.5%) between 7 and 24 months, and 13 (81%) after 25 months. The median time from transplantation to onset of TG was 45 months (IQR: 29-69). Factors such as recipient and donor age, gender, relationship, cold ischemia time, delayed graft function (DGF), HLA mismatch, historical cross-match positivity, and blood group incompatibility did not significantly influence development of TG. At the time of diagnosis of TG, a mean serum creatinine level of 2.70±1.18 mg% was associated with poor graft outcomes during follow-up, compared to a level of 1.53±0.29 mg% (P<0.001). The mean period of follow after diagnosis of TG was 42±24 months. Graft loss occurred in 9 of the 16 (56.2%) patients with TG. Graft loss occurred 11.57±7.3 months after diagnosis of TG. Two patients had graft loss at the time of diagnosis of TG. Conclusion: The incidence of TG has an increasing trend over time and is associated with decreased graft survival. Protocol biopsies facilitate the detection of subclinical TG. Elevated serum creatinine levels at the time of diagnosis of TG correlate with a higher probability of graft loss.