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Comparing transplant glomerulopathy in the absence of C4d deposition and donor‐specific antibodies to chronic antibody‐mediated rejection
Author(s) -
Torres Irina B.,
Salcedo Maite,
Moreso Francesc,
Sellarés Joana,
Castellá Eva,
Azancot M. Antonieta,
Perelló Manel,
Cantarell Carme,
Serón Daniel
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.12433
Subject(s) - medicine , antibody , immunohistochemistry , donor specific antibodies , glomerulopathy , gastroenterology , lesion , pathology , transplantation , urology , immunology , kidney , kidney transplantation , glomerulonephritis
Transplant glomerulopathy ( TG ) is the characteristic lesion of chronic antibody‐mediated rejection ( AMR ). However, in some patients presents with no circulating HLA antibodies or C4d positivity. Aim Patients with TG accomplishing criteria for chronic AMR were compared to patients with isolated TG . Patients and Methods We reviewed late (>6 months) graft biopsies performed between 2007 and 2010 (n = 75). Biopsies with C4d‐negative TG and no circulating donor‐specific antibody were called isolated TG (n = 12), and chronic AMR was defined according to Banff consensus (n = 17). HLA antibodies were evaluated by Luminex technology. Immunohistochemistry was performed to quantify graft infiltrating cells. Results Patients with isolated TG were older (52 ± 14 vs. 35 ± 14; p = 0.0048), received grafts from older donors (54 ± 16 vs. 41 ± 18; p = 0.0554), and displayed a lower inflammation in the glomerular (g‐score: 0.5 ± 0.5 vs. 1.0 ± 0.9; p = 0.0865; CD 3 positive cells/glomeruli: 1.5 ± 2.9 vs. 4.4 ± 4.1; p = 0.0147), interstitial (i‐score: 1.2 ± 0.9 vs. 1.9 ± 1.0; p = 0.0685; CD 45 positive cells/hpf: 18 ± 11 vs. 57 ± 68; p = 0.0132), and peritubular capillary (ptc‐score 0.2 ± 0.6 vs. 1.1 ± 0.9; p = 0.0089; CD 45 positive cells/hpf: 3.7 ± 3.1 vs. 10.1 ± 7.4; p = 0.0290) compartments. Fifteen grafts were lost and graft survival was significantly lower in patients with chronic AMR (p = 0.0122). Conclusion Isolated TG is associated with less severe allograft inflammation and with a better outcome than chronic AMR .