[1471] Clinical Significance of Isolated Arteritis (Banff Class 2A) in the Post-Transplant Period. A Single Institution Review.

Michael Kuperman, Lois J Arend, Serena Bagnasco, Lorraine Racusen, Mark Haas, Ed Kraus. Johns Hopkins Medical Center, Baltimore, MD; Cedars Sinai Medical Center, Los Angeles, CA

Background: Infiltration of mononuclear cells beneath the endothelial cells of arteries/arterioles is considered pathognomonic of acute cell-mediated rejection (ACR). However, it was recently shown that some biopsies diagnosed with ACR based solely on intimal arteritis (V1) do not have molecular features of rejection (Famulski, AJT 2010). We retrospectively examined renal transplant biopsies with isolated V1 lesions (minimal interstitial inflammation and tubulitis) to see how many continued to show ACR on follow-up.
Design: The patient cohort consisted of recipients of kidney transplants at Johns Hopkins Hospital from January, 2000 – June, 2009; ABO incompatible and cross-match incompatible grafts were excluded. Both for-cause and protocol biopsies were included. All C4d-negative biopsies that met Banff criteria of v=1, t<2, i<2 were collected for further study. Follow-up biopsies for each case were also examined; cases with no later biopsies were excluded.
Results: 49 cases of isolated V1 were collected; 16 were excluded due to the lack of follow-up biopsies. Of the remaining 33 cases, 23 (70%) were in deceased donor grafts. ACR on follow up biopsies was found in 4/8 (50%) isolated V1 lesions occurring during the first week, 0/6 V1 occurring from day 8-14, and 16/19 (84%) V1 occurring after week 2. Of 4 biopsies done from day 3-6 for increased serum creatinine (SCr) 3 had ACR type 1B or 2B on follow-up; only 1/5 early (day 3-14) biopsies done for delayed graft function (DGF) and 0/5 early protocol biopsies showed ACR on the follow-up biopsy.

Significance of Isolated V1 Lesions in first 2 weeks
Days 1-7Biopsy ReasonLast Bx Result
3 days↑CreatinineGrade 1B
3 days↑CreatinineGrade 2B
5 days↑CreatinineNo rejection
5 daysDGFGrade 2C
6 days↑CreatinineGrade 2B
6 daysSurveillanceNo rejection
7 daysSurveillanceNo rejection
7 daysDGFNo rejection
Days 8-14  
8 daysSurveillanceNo rejection
10 daysDGFNo rejection
10 daysDGFNo rejection
12 daysSurveillanceNo rejection
13 daysDGFNo rejection
14 days↑CreatinineNo rejection

Conclusions: Isolated V1 lesions found on early biopsies done for increased SCr and on later biopsies usually represent ACR. By contrast, such lesions found on early protocol biopsies and biopsies done for DGF are rarely associated with continued ACR on follow-up. To further investigate these findings, a multicenter study of isolated V1 lesions is currently underway.
Category: Kidney (does not include tumors)

Monday, February 28, 2011 9:30 AM

Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 196, Monday Morning


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