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.
