Association between transplant glomerulopathy and graft outcomes following kidney transplantation: A meta-analysis

PLoS One. 2020 Apr 28;15(4):e0231646. doi: 10.1371/journal.pone.0231646. eCollection 2020.


Transplant glomerulopathy (TG), a morphological lesion associated with confluent mechanisms of endothelial injury of renal allografts, may provide a viable predictor of graft failure. This systematic literature review and meta-analysis were performed according to the PRISMA statement to examine evidence describing the association between TG and graft loss or failure and time to these events. The literature review was conducted using the Scopus, EBSCO, and Cochrane Library search engines. Hazard ratios, median survival times, and 95% confidence intervals (CIs) were estimated to evaluate graft survival in the total population and prespecified subgroups. Meta-regression analysis assessed heterogeneity. Twenty-one publications comprising 6,783 patients were eligible for data extraction and inclusion in the meta-analysis. Studies were highly heterogeneous (I2 = 67.3%). The combined hazard ratio of graft loss or failure from random-effects meta-analysis was 3.11 (95% CI 2.44-3.96) in patients with TG compared with those without. Median graft survival in patients with TG was 3.25 (95% CI 0.94-11.21) years-15 years shorter than in those without TG (18.82 [95% CI 10.03-35.32] years). The effect of time from transplantation to biopsy on graft outcomes did not reach statistical significance (p = 0.116). TG was associated with a threefold increase in the risk of graft loss or failure and a 15-year loss in graft survival, indicating viability as a surrogate measure for both clinical practice and studies designed to prevent or reverse antibody-mediated rejection.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Female
  • Glomerulonephritis / epidemiology*
  • Graft Rejection / epidemiology*
  • Humans
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / statistics & numerical data
  • Male
  • Postoperative Complications / epidemiology*

Grant support

Shire Human Genetic Therapies, Inc., a Takeda company, provided funding to Excel Medical Affairs for support in writing and editing this manuscript. The interpretation of the data was made by the authors independently. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.