{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:46:04Z","timestamp":1791639964442,"version":"4.3.4"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["RD21\/0005\/0010"],"award-info":[{"award-number":["RD21\/0005\/0010"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["RD21\/0005\/0012"],"award-info":[{"award-number":["RD21\/0005\/0012"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Immunoglobulin A nephropathy (IgAN) is the most frequent recurrent disease in kidney transplant recipients and its recurrence contributes to reducing graft survival. Several variables at the time of recurrence have been associated with a higher risk of graft loss. The presence of clinical or subclinical inflammation has been associated with a higher risk of kidney graft loss, but it is not precisely known how it influences the outcome of patients with recurrent IgAN.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a multicentre retrospective study including kidney transplant recipients with biopsy-proven recurrence of IgAN in which Banff and Oxford classification scores were available. \u2018Tubulo-interstitial inflammation\u2019 (TII) was defined when \u2018t\u2019 or \u2018i\u2019 were \u22652. The main endpoint was progression to chronic kidney disease (CKD) stage 5 or to death censored-graft loss (CKD5\/DCGL).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 119 kidney transplant recipients with IgAN recurrence were included and 23 of them showed TII. Median follow-up was 102.9\u00a0months and 39 (32.8%) patients reached CKD5\/DCGL. TII related to a higher risk of CKD5\/DCGL (3\u00a0years 18.0% vs 45.3%, log-rank 7.588, P\u00a0=\u00a0.006). After multivariate analysis, TII remained related to the risk of CKD5\/DCGL (HR 2.344, 95% CI 1.119\u20134.910, P\u00a0=\u00a0.024) independently of other histologic and clinical variables.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In kidney transplant recipients with IgAN recurrence, TII contributes to increasing the risk of CKD5\/DCGL independently of previously well-known variables. We suggest adding TII along with the Oxford classification to the clinical variables to identify recurrent IgAN patients at increased risk of graft loss who might benefit from intensified immunosuppression or specific IgAN therapies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfad259","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:36:27Z","timestamp":1697502987000},"source":"Crossref","is-referenced-by-count":3,"title":["Tubulo-interstitial inflammation increases the risk of graft loss after the recurrence of IgA nephropathy"],"prefix":"10.1093","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2845-5272","authenticated-orcid":false,"given":"Emilio","family":"Rodrigo","sequence":"first","affiliation":[{"name":"Nephrology Department, Hospital Universitario Marqu\u00e9s de Valdecilla\/IDIVAL , Santander , Spain RD21\/0005\/0010 (ISCIII RICORS2040)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7582-8476","authenticated-orcid":false,"given":"Luis F","family":"Quintana","sequence":"additional","affiliation":[{"name":"Nephrology and Renal Transplantation Department, Hospital Clinic , Barcelona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"V\u00e1zquez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Regional , M\u00e1laga , Spain RD21\/0005\/0010 (ISCIII RICORS2040)"},{"name":"de M\u00e1laga , M\u00e1laga , Spain RD21\/0005\/0010 (ISCIII RICORS2040)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7017-9729","authenticated-orcid":false,"given":"Ana","family":"S\u00e1nchez-Fructuoso","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Cl\u00ednico San Carlos, Facultad de Medicina Universidad Complutense, Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7305-3259","authenticated-orcid":false,"given":"Anna","family":"Buxeda","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital del Mar , Barcelona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1163-4853","authenticated-orcid":false,"given":"Eva","family":"Gavela","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitari Dr Peset, FISABIO , Valencia , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan M","family":"Cazorla","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Puerta del Mar , C\u00e1diz , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9319-6935","authenticated-orcid":false,"given":"Sheila","family":"Cabello","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Son Espases , Mallorca , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8433-3448","authenticated-orcid":false,"given":"Isabel","family":"Beneyto","sequence":"additional","affiliation":[{"name":"Kidney Transplant Unit, Nephrology Department, Hospital Universitario La Fe , Valencia , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3503-3518","authenticated-orcid":false,"given":"Mar\u00eda O","family":"L\u00f3pez-Oliva","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario La Paz , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6199-3016","authenticated-orcid":false,"given":"Fritz","family":"Diekmann","sequence":"additional","affiliation":[{"name":"Nephrology and Renal Transplantation Department, Hospital Clinic , Barcelona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 M","family":"G\u00f3mez-Ortega","sequence":"additional","affiliation":[{"name":"Pathology Department, Hospital Universitario Marqu\u00e9s de Valdecilla\/IDIVAL , Santander , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4031-4816","authenticated-orcid":false,"given":"Natividad","family":"Calvo Romero","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Cl\u00ednico San Carlos, Facultad de Medicina Universidad Complutense, Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8601-2699","authenticated-orcid":false,"given":"Mar\u00eda J","family":"P\u00e9rez-S\u00e1ez","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital del Mar , Barcelona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4170-9003","authenticated-orcid":false,"given":"Asunci\u00f3n","family":"Sancho","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitari Dr Peset, FISABIO , Valencia , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5860-2309","authenticated-orcid":false,"given":"Auxiliadora","family":"Mazuecos","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Puerta del Mar , C\u00e1diz , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2443-1035","authenticated-orcid":false,"given":"Jordi","family":"Esp\u00ed-Reig","sequence":"additional","affiliation":[{"name":"Kidney Transplant Unit, Nephrology Department, Hospital Universitario La Fe , Valencia , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9680-3259","authenticated-orcid":false,"given":"Carlos","family":"Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario La Paz , Madrid , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5469-2119","authenticated-orcid":false,"given":"Domingo","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario Regional , M\u00e1laga , Spain RD21\/0005\/0010 (ISCIII RICORS2040)"},{"name":"de M\u00e1laga , M\u00e1laga , Spain RD21\/0005\/0010 (ISCIII RICORS2040)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"2024010515580438500_bib1","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1097\/TP.0000000000001657","article-title":"Kidney transplantation rates across glomerulonephritis subtypes in the United States","volume":"101","author":"O\u02bcShaughnessy","year":"2017","journal-title":"Transplantation"},{"key":"2024010515580438500_bib2","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.kint.2017.03.015","article-title":"Recurrent glomerulonephritis after kidney transplantation: risk factors and allograft outcomes","volume":"92","author":"Allen","year":"2017","journal-title":"Kidney Int"},{"key":"2024010515580438500_bib3","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1093\/ndt\/gfs472","article-title":"The long-term outcome of renal transplantation of IgA nephropathy and the impact of recurrence on graft survival","volume":"28","author":"Moroni","year":"2013","journal-title":"Nephrol Dial Transplant"},{"key":"2024010515580438500_bib4","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/ajt.14908","article-title":"Glomerular crescents are associated with worse graft outcome in allograft IgA nephropathy","volume":"19","author":"Park","year":"2019","journal-title":"Am J Transplant"},{"key":"2024010515580438500_bib5","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.2215\/CJN.00910121","article-title":"Recurrence of IgA nephropathy after kidney transplantation in adults","volume":"16","author":"Uffing","year":"2021","journal-title":"Clin J Am Soc Nephrol"},{"key":"2024010515580438500_bib6","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1159\/000519834","article-title":"Clinical predictors and prognosis of recurrent IgA nephropathy in the kidney allograft","volume":"2","author":"Kavanagh","year":"2022","journal-title":"Glomerular Dis"},{"key":"2024010515580438500_bib7","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1001\/jamainternmed.2019.0600","article-title":"Evaluating a new International risk-prediction tool in IgA nephropathy","volume":"179","author":"Barbour","year":"2019","journal-title":"JAMA Intern Med"},{"key":"2024010515580438500_bib8","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1053\/j.ajkd.2004.09.030","article-title":"IgA nephropathy with crescents in kidney transplant recipients","volume":"45","author":"Kowalewska","year":"2005","journal-title":"Am J Kidney Dis"},{"key":"2024010515580438500_bib9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1744-9987.2012.01139.x","article-title":"Risk factors for recurrence of immunoglobulin a nephropathy after renal transplantation: single center study","volume":"17","author":"Sato","year":"2013","journal-title":"Ther Apher Dial"},{"key":"2024010515580438500_bib10","doi-asserted-by":"crossref","first-page":"2855","DOI":"10.1111\/ajt.15400","article-title":"Clinical importance of the updated Oxford classification in allograft IgA nephropathy","volume":"19","author":"Park","year":"2019","journal-title":"Am J Transplant"},{"key":"2024010515580438500_bib11","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.transproceed.2019.12.008","article-title":"IgA nephropathy after renal transplant: recurrences and de novo cases","volume":"52","author":"Cazorla-L\u00f3pez","year":"2020","journal-title":"Transplant Proc"},{"key":"2024010515580438500_bib12","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1016\/j.transproceed.2017.10.002","article-title":"Utility of Oxford classification in post-transplant immunoglobulin A nephropathy","volume":"49","author":"Agrawal","year":"2017","journal-title":"Transplant Proc"},{"key":"2024010515580438500_bib13","doi-asserted-by":"crossref","first-page":"312","DOI":"10.4103\/ijn.ijn_234_21","article-title":"Two decades outcomes of posttransplant immunoglobulin A nephropathy in live donor renal transplantation","volume":"32","author":"Khurana","year":"2022","journal-title":"Indian J Nephrol"},{"key":"2024010515580438500_bib14","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1159\/000453081","article-title":"Predicting post-transplant recurrence of IgA nephropathy: the importance of crescents","volume":"45","author":"Avasare","year":"2017","journal-title":"Am J Nephrol"},{"key":"2024010515580438500_bib15","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1007\/s40620-020-00914-x","article-title":"Glomerular C4d in post-transplant IgA nephropathy is associated with decreased allograft survival","volume":"34","author":"Eder","year":"2021","journal-title":"J Nephrol"},{"key":"2024010515580438500_bib16","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1159\/000524585","article-title":"Renal interstitial inflammation predicts nephropathy progression in IgA nephropathy: a two-center cohort study","volume":"53","author":"Zhu","year":"2022","journal-title":"Am J Nephrol"},{"key":"2024010515580438500_bib17","doi-asserted-by":"crossref","first-page":"e0159717","DOI":"10.1371\/journal.pone.0159717","article-title":"Decreased kidney graft survival in low immunological risk patients showing inflammation in normal protocol biopsies","volume":"11","author":"Ortiz","year":"2016","journal-title":"PLoS One"},{"key":"2024010515580438500_bib18","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1111\/ajt.15197","article-title":"The clinical and pathological significance of borderline T cell-mediated rejection","volume":"19","author":"Nankivell","year":"2019","journal-title":"Am J Transplant"},{"key":"2024010515580438500_bib19","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1097\/TP.0000000000002682","article-title":"Subclinical inflammation in renal transplantation","volume":"103","author":"Rush","year":"2019","journal-title":"Transplantation"},{"key":"2024010515580438500_bib20","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1097\/TP.0000000000001216","article-title":"Inflammation in early kidney allograft surveillance biopsies with and without associated tubulointerstitial chronic damage as a predictor of fibrosis progression and development of de novo donor specific antibodies","volume":"101","author":"Garc\u00eda-Carro","year":"2017","journal-title":"Transplantation"},{"key":"2024010515580438500_bib21","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.kint.2022.07.030","article-title":"Long-term immunological outcomes of early subclinical inflammation on surveillance kidney allograft biopsies","volume":"102","author":"Mehta","year":"2022","journal-title":"Kidney Int"},{"key":"2024010515580438500_bib22","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/ajt.14625","article-title":"The Banff 2017 Kidney Meeting Report: revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials","volume":"18","author":"Haas","year":"2018","journal-title":"Am J Transplant"},{"key":"2024010515580438500_bib23","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1016\/j.kint.2017.02.003","article-title":"Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group","volume":"91","author":"Trimarchi","year":"2017","journal-title":"Kidney Int"},{"key":"2024010515580438500_bib24","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1111\/j.1600-6143.2011.03667.x","article-title":"Steroids and recurrent IgA nephropathy after kidney transplantation","volume":"11","author":"Clayton","year":"2011","journal-title":"Am J Transplant"},{"key":"2024010515580438500_bib25","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1097\/TP.0b013e3181705ad4","article-title":"Antithymocyte globulin (ATG) induction therapy and disease recurrence in renal transplant recipients with primary IgA nephropathy","volume":"85","author":"Berthoux","year":"2008","journal-title":"Transplantation"},{"key":"2024010515580438500_bib26","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s12882-022-02802-x","article-title":"Recurrence of IgA nephropathy after kidney transplantation: experience from the Swiss transplant cohort study","volume":"23","author":"J\u00e4ger","year":"2022","journal-title":"BMC Nephrol"},{"key":"2024010515580438500_bib27","doi-asserted-by":"crossref","first-page":"10693","DOI":"10.3389\/ti.2022.10693","article-title":"Enteric budesonide in transplant and native IgA nephropathy: real-world clinical practice","volume":"35","author":"Lopez-Martinez","year":"2022","journal-title":"Transpl Int"},{"key":"2024010515580438500_bib28","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1016\/j.ekir.2022.05.017","article-title":"Randomized phase II JANUS study of atacicept in patients with IgA nephropathy and persistent proteinuria","volume":"7","author":"Barratt","year":"2022","journal-title":"Kidney Int Rep"},{"key":"2024010515580438500_bib29","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.3390\/jcm10091934","article-title":"Impact of HLA mismatching on early subclinical inflammation in low-immunological-risk kidney transplant recipients","volume":"10","author":"Hern\u00e1ndez","year":"2021","journal-title":"J Clin Med"},{"key":"2024010515580438500_bib30","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1681\/ASN.2010101073","article-title":"The inflammatory cytokines TWEAK and TNF-\u03b1 reduce renal klotho expression through NF\u03baB","volume":"22","author":"Moreno","year":"2011","journal-title":"J Am Soc Nephrol"},{"key":"2024010515580438500_bib31","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1038\/ki.2009.243","article-title":"The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification","volume":"76","author":"Working Group of the International IgA Nephropathy Network and the Renal Pathology Society","year":"2009","journal-title":"Kidney Int"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfad259\/53253334\/sfad259.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/17\/1\/sfad259\/55105827\/sfad259.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/17\/1\/sfad259\/55105827\/sfad259.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T15:58:47Z","timestamp":1704470327000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfad259\/7319359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,16]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,10,16]]},"published-print":{"date-parts":[[2024,1,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfad259","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,1]]},"published":{"date-parts":[[2023,10,16]]},"article-number":"sfad259"}}