Microcirculation Inflammation in Kidney Transplant Biopsies: Relationship to Diseases and Transplant Outcomes.
Banu Sis, Gian Jhangri, Julie Riopel, Hakimah Mahsin, Jessica Chang, Michael Mengel, Declan de Freitas, Joana Sellares, Stephen Osasan, Bruce Kaplan, Philip Halloran. University of Alberta, Edmonton, Canada; University of Arizona, Tucson
Background: We studied the significance of microcirculation inflammation – glomerulitis and peritubular capillaritis – in kidney transplants in relationship to diseases and outcomes.
Design: We examined 221 renal allograft biopsies for cause from 169 patients (median follow-up after biopsy 32 months).
Results: Glomerulitis (g) and peritubular capillaritis (ptc) were associated with antibody-mediated rejection (ABMR) (63% and 70%, respectively), but were not specific because they were also seen in other diseases (T cell-mediated rejection, glomerulonephritis, acute tubular necrosis). In univariate analysis, all g>0 grades and ptc2,3 predicted poor survival, but ptc1 did not. In multivariate analysis, the combination of g>0 plus ptc>1 independently predicted poor survival, but either g>0 or ptc>1, C4d, alloantibody, and transplant glomerulopathy did not. Transplant glomerulopathy with g>0 plus ptc>1 showed accelerated graft loss, but transplant glomerulopathy without this combination showed an indolent course. The majority (89%) of biopsies with g>0 plus ptc>1 was antibody-mediated rejection (C4d +/-). In multivariate analysis of ABMR patients, concurrent g>0 plus ptc>1 was the only independent predictor of graft loss.
Conclusions: Thus, the combination of glomerulitis (g>0) plus peritubular capillaritis (ptc>1) in the presence of DSA should be recognized as active antibody-mediated rejection with a high risk for graft failure, without requiring C4d staining.
Category: Kidney (does not include tumors)
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 270, Wednesday Afternoon