1. Gene Expression in Biopsies of Acute Rejection and Interstitial Fibrosis/Tubular Atrophy Reveals Highly Shared Mechanisms That Correlate With Worse Long‐Term Outcomes
- Author
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Modena, B. D., Kurian, S. M., Gaber, L. W., Waalen, J., Su, A. I., Gelbart, T., Mondala, T. S., Head, S. R., Papp, S., Heilman, R., Friedewald, J. J., Flechner, S. M., Marsh, C. L., Sung, R. S., Shidban, H., Chan, L., Abecassis, M. M., and Salomon, D. R.
- Abstract
Interstitial fibrosis and tubular atrophy (IFTA) is found in approximately 25% of 1‐year biopsies posttransplant. It is known that IFTAcorrelates with decreased graft survival when histological evidence of inflammation is present. Identifying the mechanistic etiology of IFTAis important to understanding why long‐term graft survival has not changed as expected despite improved immunosuppression and dramatically reduced rates of clinical acute rejection (AR) (Services UDoHaH. http://www.ustransplant.org/annual_reports/current/509a_ki.htm). Gene expression profiles of 234 graft biopsy samples were obtained with matching clinical and outcome data. Eighty‐one IFTAbiopsies were divided into subphenotypes by degree of histological inflammation: IFTAwith AR,IFTAwith inflammation, and IFTAwithout inflammation. Samples with AR(n = 54) and normally functioning transplants (TX; n = 99) were used in comparisons. A novel analysis using gene coexpression networks revealed that all IFTAphenotypes were strongly enriched for dysregulated gene pathways and these were shared with the biopsy profiles of AR, including IFTAsamples without histological evidence of inflammation. Thus, by molecular profiling we demonstrate that most IFTAsamples have ongoing immune‐mediated injury or chronic rejection that is more sensitively detected by gene expression profiling. These molecular biopsy profiles correlated with future graft loss in IFTAsamples without inflammation. In this multicenter study featuring gene expression profiles with matching demographic and long‐term follow‐ up data, the authors demonstrate that biopsies with interstitial fibrosis and tubular atrophy without alternative explanations for pathogenesis and regardless of histological reads with or without inflammation, have significantly worse graft survival than those with biopsy‐proven normal transplant histology and differential gene expression changes that indicate ongoing cellular immune‐mediated injury that correlate with worse long‐term outcomes. See Maluf et al's editorial on page 1947.
- Published
- 2016
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