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Usefulness of Oxford Classification in Assessing Immunoglobulin A Nephropathy After Transplantation

 Beom Jin Lim  ;  Dong Jin Joo  ;  Myoung Soo Kim  ;  Yu Seun Kim  ;  Soon Il Kim  ;  Yeonhee Kim  ;  Kyu Ha Huh  ;  Myung Ju Koh  ;  Hyeon Joo Jeong 
 TRANSPLANTATION, Vol.95(12) : 1491-1497, 2013 
Journal Title
Issue Date
Adult ; Biopsy ; Cell Proliferation ; Female ; Fibrosis/pathology ; Glomerular Filtration Rate ; Glomerulonephritis, IGA/classification* ; Glomerulonephritis, IGA/diagnosis* ; Glomerulosclerosis, Focal Segmental/diagnosis ; Graft Survival ; Humans ; Kidney Glomerulus/pathology ; Kidney Transplantation/adverse effects* ; Male ; Middle Aged ; Postoperative Complications ; Renal Insufficiency/complications ; Renal Insufficiency/surgery* ; Young Adult
IgA nephropathy ; Oxford classification ; Endocapillary proliferation ; Segmental glomerulosclerosis ; Transplantation
BACKGROUND: We explored the efficacy of the Oxford classification for assessing native immunoglobulin A nephropathy (IgAN) in posttransplantation patients compared with the glomerular injury score and Haas classification. METHODS: A total of 125 renal allograft biopsies obtained from 114 patients diagnosed with IgAN regardless of original disease were assessed. RESULTS: The average time to biopsy was 70.5±45.3 months after transplantation. Glomeruli showed normal histology in 18.4%. Mesangial hypercellularity (M1), endocapillary hypercellularity (E1), segmental glomerulosclerosis (S1), and tubulointerstitial fibrosis (T1-2) were present in 12.8%, 6.4%, 45.6%, and 20.8% of the samples, respectively. There was a significant correlation between Oxford-MEST scores and glomerular injury score or Haas subclass. S1 and T1-2 were correlated with elevated serum creatinine level, proteinuria, and decreased estimated glomerular filtration rate, and E1 was correlated with decreased estimated glomerular filtration rate at the time of biopsy. The 10- and 15-year graft survival rates were 62.9% and 34.3%, respectively. The graft survival rate was significantly lower in the presence of S1 and T1-2. Endocapillary hypercellularity, segmental sclerosis, and tubulointerstitial fibrosis predicted graft survival and endocapillary hypercellularity and tubulointerstitial fibrosis also predicted serum creatinine doubling. CONCLUSIONS: The Oxford classification scheme is useful for evaluating chronic graft dysfunction in patients with posttransplantation IgAN. In addition to tubulointerstitial fibrosis, the presence of endocapillary hypercellularity and segmental sclerosis should be included in the pathology report.
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1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Lim, Beom Jin(임범진) ORCID logo https://orcid.org/0000-0003-2856-0133
Jeong, Hyeon Joo(정현주) ORCID logo https://orcid.org/0000-0002-9695-1227
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Huh, Kyu Ha(허규하) ORCID logo https://orcid.org/0000-0003-1364-6989
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