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Histopathologic features of transplant glomerulopathy associated with response to therapy with intravenous immune globulin and rituximab
Author(s) -
Kahwaji Joseph,
Najjar Reiad,
Kancherla Deepika,
Villicana Rafael,
Peng Alice,
Jordan Stanley,
Vo Ashley,
Haas Mark
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12345
Subject(s) - medicine , rituximab , creatinine , gastroenterology , concomitant , biopsy , urology , kidney transplantation , transplantation , antibody , immunology
Transplant glomerulopathy ( TG ) is associated with poor long‐term allograft survival and is often accompanied by microcirculation inflammation. Histopathologic scoring may inform prognosis and help guide therapy. We retrospectively assessed 33 patients with biopsy‐proven TG . All biopsies were given a glomerulitis (g) and peritubular capillaritis (ptc) score. We determined allograft survival and serum creatinine stability in three different score groups: g < 2 and ≥ 2, ptc < 2 and ≥ 2, and (g + ptc) < 4 and ≥ 4. We assessed the impact of treatment with intravenous immune globulin ( IVIG ) and rituximab on outcomes. Graft survival and serum creatinine stability did not differ in each of the histopathologic score groups. Higher‐score groups were associated with the presence of concomitant antibody‐mediated rejection and were more likely to receive IVIG and rituximab. Treatment with IVIG and rituximab resulted in stability of serum creatinine within the higher‐score groups, but not in the lower‐score groups. Stabilization of serum creatinine was associated with an improvement in donor‐specific antibody. Histopathologic scoring in kidney allograft biopsies with TG may help guide treatment. The combination of IVIG and rituximab appears to be beneficial in patients whose biopsies have moderate or severe microvascular injury.