COMMENTARY

A Bad Sign for Renal Allograft Survival Teaser

Ron Shapiro, MD

Disclosures

August 25, 2010

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Hi, my name is Ron Shapiro. I'm a transplant surgeon at the University of Pittsburgh. Today I want to talk to you about an interesting observation from the DeKAF [Long-term Deterioration of Kidney Allograft Function] study, which looked at long-term deterioration of renal allograft survival.[1]

This particular study looked at biopsies in patients who had late deterioration of renal allograft function and found that antibody-mediated rejection was an important negative prognostic factor in late allograft loss. C4d positivity, in particular, in late biopsies was an important negative prognostic factor in patients losing their kidneys.

The causes of long-term graft deterioration after kidney transplantation are multifactorial, but I believe that we have, up until now, really ignored the impact of antibody-mediated processes. It is clear that we will need to look at these more carefully if we are to prevent some aspects of long-term graft dysfunction and failure.

This study is an important warning to those of us who have been expecting that the grafts are going to fail long-term (and not worrying too much about it), suggesting that there are, in fact, some immunologic processes going on that we need to be aware of and that we need to address. Thank you.

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