Mesangial expansion at 5 years predicts death and death-censored graft loss after renal transplantation

Aleksandra Kukla, Mariam P. Alexander, Sandor Turkevi-Nagy, Massini Merzkani, Walter Park, Byron Smith, Pingchuan Zhang, Xiomara Benavides, Matthew D'Costa, Catalina Morales Alvarez, Aleksandar Denic, Andrew Bentall, Yogish C. Kudva, Mark Stegall

Research output: Contribution to journalArticlepeer-review


Death with a functioning graft and death-censored renal allograft failure remain major problems for which effective preventative protocols are lacking. The retrospective cohort study aimed to determine whether histologic changes on a 5-year surveillance kidney biopsy predict adverse outcomes after transplantation in recipients who had: both Type 2 diabetes (T2DM) and obesity (BMI ≥ 30 kg/m2) at the time of transplantation (T2DM/Obesity, n = 75); neither (No T2DM/No obesity, n = 78); No T2DM/Obesity (n = 41), and T2DM/No obesity (n = 47). On 5-year biopsies, moderate-to-severe mesangial expansion was more common in the T2DM/Obesity group (Banff mm score ≥2 = 49.3%; Tervaert classification MS ≥ 2b = 26.7%) compared to the other groups (p <.001 for both scores). Risk factors included older age, higher BMI, HbA1C, and triglycerides at 1-year post-transplant. Moderate-to-severe mesangial expansion correlated with death with function (HR 1.74 (1.01, 2.98), p =.045 Banff and 1.89 (1.01, 3.51) p =.045 Tervaert) and with death-censored graft loss (HR 3.2 (1.2, 8.8), p =.02 Banff and HR 3.8 (1.3, 11.5), p =.01 Tervaert) over a mean of 11.6 years of recipient follow-up post-transplant. These data suggest that mesangial expansion in recipients with T2DM and obesity may reflect systemic vascular injury and might be a novel biomarker to predict adverse outcomes post renal transplant.

Original languageEnglish (US)
Article numbere14147
JournalClinical Transplantation
Issue number1
StatePublished - Jan 2021


  • diabetes
  • graft survival
  • kidney transplant
  • mesangial expansion
  • patient survival

ASJC Scopus subject areas

  • Transplantation


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