Plasma cell infiltrates and renal allograft outcomes in indigenous and non-indigenous people of the Northern Territory of Australia

Natasha M. Rogers, Paul D. Lawton, Matthew D. Jose

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction: Plasma cell-rich rejection is a distincthistological phenomenon associated with poor renal allograft outcomes.Aboriginal and Torres Straight Islander (ATSI) transplant recipients havepoorer allograft survival and higher rates of acute rejection. We sought todetermine whether a higher incidence of plasma cell-rich infiltrates (PCIR)could account for poorer survival.

Methods: Renal transplant biopsies performed in recipients from theNorthern Territory of Australia between 1985 and 2007 were reviewed and correlatedwith outcome. Biopsies were designated PCIR positive when plasma cellsconstituted >10% of the interstitial infiltrate.

Results: Four hundred and seventy-seven biopsies from 177 recipients(108 ATSI) were performed. Median graft survival was shorter for recipientswith PCIR: 4.0 years (interquartile range 2.18-6.41) versus 5.4 years(2.0-9.99) (P = 0.013). ATSI recipients had higher rates of plasma cell-richrejection (RR 1.76, 95% CI 1.43-2.17, P< 0.0001), which occurred earlier(251 vs 869 days, P = 0.03) compared with non-indigenous recipients. Onmultivariate analysis, PCIR did not independently influence allograft survival.There was a correlation between PCIR and panel reactive antibody peak >20%(RR 1.29, 95% CI 1.03-1.56, P = 0.025), ≥5 human leukocyte antigen mismatches(RR 1.91, 1.41-2.58, p< 0.0001), increasing post-transplant infection rate(>10 infections RR 5.11, 1.69-15.5, P = 0.004), and subsequent death fromsepticaemia (RR 1.6, 1.17-2.18, P = 0.003).

Conclusion: PCIR is associated with infection and markers ofchronic immunological stimulation but does not independently contribute toinferior renal allograft outcomes, even in ATSI recipients.

Original languageEnglish
Pages (from-to)777-783
Number of pages7
JournalNephrology
Volume16
Issue number8
DOIs
Publication statusPublished - Nov 2011
Externally publishedYes

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Northern Territory
Plasma Cells
Allografts
Kidney
Biopsy
Graft Survival
HLA Antigens
Infection
Immunization
Survival Rate
Transplants
Survival
Incidence

Cite this

@article{a8b7d4f36d084a5d945ace6b75254cb2,
title = "Plasma cell infiltrates and renal allograft outcomes in indigenous and non-indigenous people of the Northern Territory of Australia",
abstract = "Introduction: Plasma cell-rich rejection is a distincthistological phenomenon associated with poor renal allograft outcomes.Aboriginal and Torres Straight Islander (ATSI) transplant recipients havepoorer allograft survival and higher rates of acute rejection. We sought todetermine whether a higher incidence of plasma cell-rich infiltrates (PCIR)could account for poorer survival. Methods: Renal transplant biopsies performed in recipients from theNorthern Territory of Australia between 1985 and 2007 were reviewed and correlatedwith outcome. Biopsies were designated PCIR positive when plasma cellsconstituted >10{\%} of the interstitial infiltrate. Results: Four hundred and seventy-seven biopsies from 177 recipients(108 ATSI) were performed. Median graft survival was shorter for recipientswith PCIR: 4.0 years (interquartile range 2.18-6.41) versus 5.4 years(2.0-9.99) (P = 0.013). ATSI recipients had higher rates of plasma cell-richrejection (RR 1.76, 95{\%} CI 1.43-2.17, P< 0.0001), which occurred earlier(251 vs 869 days, P = 0.03) compared with non-indigenous recipients. Onmultivariate analysis, PCIR did not independently influence allograft survival.There was a correlation between PCIR and panel reactive antibody peak >20{\%}(RR 1.29, 95{\%} CI 1.03-1.56, P = 0.025), ≥5 human leukocyte antigen mismatches(RR 1.91, 1.41-2.58, p< 0.0001), increasing post-transplant infection rate(>10 infections RR 5.11, 1.69-15.5, P = 0.004), and subsequent death fromsepticaemia (RR 1.6, 1.17-2.18, P = 0.003). Conclusion: PCIR is associated with infection and markers ofchronic immunological stimulation but does not independently contribute toinferior renal allograft outcomes, even in ATSI recipients.",
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Plasma cell infiltrates and renal allograft outcomes in indigenous and non-indigenous people of the Northern Territory of Australia. / Rogers, Natasha M.; Lawton, Paul D.; Jose, Matthew D.

In: Nephrology, Vol. 16, No. 8, 11.2011, p. 777-783.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Plasma cell infiltrates and renal allograft outcomes in indigenous and non-indigenous people of the Northern Territory of Australia

AU - Rogers, Natasha M.

AU - Lawton, Paul D.

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N2 - Introduction: Plasma cell-rich rejection is a distincthistological phenomenon associated with poor renal allograft outcomes.Aboriginal and Torres Straight Islander (ATSI) transplant recipients havepoorer allograft survival and higher rates of acute rejection. We sought todetermine whether a higher incidence of plasma cell-rich infiltrates (PCIR)could account for poorer survival. Methods: Renal transplant biopsies performed in recipients from theNorthern Territory of Australia between 1985 and 2007 were reviewed and correlatedwith outcome. Biopsies were designated PCIR positive when plasma cellsconstituted >10% of the interstitial infiltrate. Results: Four hundred and seventy-seven biopsies from 177 recipients(108 ATSI) were performed. Median graft survival was shorter for recipientswith PCIR: 4.0 years (interquartile range 2.18-6.41) versus 5.4 years(2.0-9.99) (P = 0.013). ATSI recipients had higher rates of plasma cell-richrejection (RR 1.76, 95% CI 1.43-2.17, P< 0.0001), which occurred earlier(251 vs 869 days, P = 0.03) compared with non-indigenous recipients. Onmultivariate analysis, PCIR did not independently influence allograft survival.There was a correlation between PCIR and panel reactive antibody peak >20%(RR 1.29, 95% CI 1.03-1.56, P = 0.025), ≥5 human leukocyte antigen mismatches(RR 1.91, 1.41-2.58, p< 0.0001), increasing post-transplant infection rate(>10 infections RR 5.11, 1.69-15.5, P = 0.004), and subsequent death fromsepticaemia (RR 1.6, 1.17-2.18, P = 0.003). Conclusion: PCIR is associated with infection and markers ofchronic immunological stimulation but does not independently contribute toinferior renal allograft outcomes, even in ATSI recipients.

AB - Introduction: Plasma cell-rich rejection is a distincthistological phenomenon associated with poor renal allograft outcomes.Aboriginal and Torres Straight Islander (ATSI) transplant recipients havepoorer allograft survival and higher rates of acute rejection. We sought todetermine whether a higher incidence of plasma cell-rich infiltrates (PCIR)could account for poorer survival. Methods: Renal transplant biopsies performed in recipients from theNorthern Territory of Australia between 1985 and 2007 were reviewed and correlatedwith outcome. Biopsies were designated PCIR positive when plasma cellsconstituted >10% of the interstitial infiltrate. Results: Four hundred and seventy-seven biopsies from 177 recipients(108 ATSI) were performed. Median graft survival was shorter for recipientswith PCIR: 4.0 years (interquartile range 2.18-6.41) versus 5.4 years(2.0-9.99) (P = 0.013). ATSI recipients had higher rates of plasma cell-richrejection (RR 1.76, 95% CI 1.43-2.17, P< 0.0001), which occurred earlier(251 vs 869 days, P = 0.03) compared with non-indigenous recipients. Onmultivariate analysis, PCIR did not independently influence allograft survival.There was a correlation between PCIR and panel reactive antibody peak >20%(RR 1.29, 95% CI 1.03-1.56, P = 0.025), ≥5 human leukocyte antigen mismatches(RR 1.91, 1.41-2.58, p< 0.0001), increasing post-transplant infection rate(>10 infections RR 5.11, 1.69-15.5, P = 0.004), and subsequent death fromsepticaemia (RR 1.6, 1.17-2.18, P = 0.003). Conclusion: PCIR is associated with infection and markers ofchronic immunological stimulation but does not independently contribute toinferior renal allograft outcomes, even in ATSI recipients.

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