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Turkish Journal of Medical Sciences

Abstract

Background/aim: Posttransplant glomerulonephritis (GN) is an underrecognized but clinically important cause of allograft dysfunction. It remains uncertain whether GN detected in a clinically indicated kidney allograft biopsy provides prognostic information beyond graft function and chronic histological injury. The present study evaluates the association between biopsy-detected GN and death-censored graft loss.

Materials and methods: Included in this retrospective single-center study were kidney transplant recipients (KTRs) who underwent clinically indicated allograft biopsy between May 2012 and October 2025. The primary outcome was death-censored graft loss, defined as a return to kidney replacement therapy. Postbiopsy graft survival was assessed using Kaplan–Meier analysis and sequential parsimonious Cox models.

Results: Of the 120 KTRs in the study, 35 (29.2%) had biopsy-detected GN. Median death-censored graft survival was 2.19 years in the GN group and 7.71 years in the non-GN group (log-rank p = 0.005). GN was associated with graft loss in univariable analysis (HR, 2.04; 95% CI, 1.22–3.40; p = 0.006). In the main multivariable model adjusted for age, sex, biopsy estimated glomerular filtration rate, and interstitial fibrosis/tubular atrophy grade I–III, GN remained associated with graft loss (HR, 1.84; 95% CI, 1.06–3.18; p = 0.030). A multiple-imputation sensitivity analysis of the full cohort showed that additional adjustment for proteinuria attenuated the GN estimate (HR, 1.46; 95% CI, 0.84–2.54). The proportional hazards assumption was not satisfied for GN, and exploratory time-varying analysis suggested that the association may have varied over follow-up; however, later estimates were imprecise as few recipients with GN remained at risk.

Conclusion: In this indication-biopsy cohort, biopsy-detected GN was associated with poorer death-censored graft survival after adjustment for graft function and chronic histological injury; however, this association was attenuated after additional adjustment for proteinuria. The magnitude and temporal pattern of the association require confirmation in larger cohorts.

Author ORCID Identifier

HATİCE ŞAHİN: 0000-0002-7146-4828

FATMA AYERDEN EBİNÇ: 0000-0002-7893-3498

GÜLAY ULUSAL OKYAY: 0000-0003-0770-1283

EMRE YAŞAR: 0000-0001-8271-1831

EBRU GÖK OĞUZ: 0000-0002-2606-3865

FEVZİ COŞKUN SÖKMEN: 0000-0002-5621-8274

KADİR GÖKHAN ATILGAN: 0000-0001-9905-4305

EBRU ŞEBNEM AYVA: 0000-0002-2280-8778

MEHMET DENİZ AYLI: 0000-0003-3145-1595

DOI

10.55730/1300-0144.6386

Keywords

Allograft biopsy, glomerulonephritis, graft loss, kidney transplantation

First Page

1406

Last Page

1419

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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