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Clinical and pathological analyses of chronic vascular rejection after kidney transplantation
Author(s) -
Shimizu Tomokazu,
Toma Hiroshi,
Shibahara Rumi,
Tsunoyama Kuniko,
Izuka Junpei,
Nozaki Taiji,
Ishida Hideki,
Tanabe Kazunari,
Honda Kazuho,
Koike Junki
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12464
Subject(s) - medicine , pathological , transplantation , biopsy , kidney transplantation , renal function , kidney , human leukocyte antigen , renal biopsy , urology , gastroenterology , clinical significance , surgery , pathology , antigen , immunology
Aim We discuss the clinicopathological analysis of cases of chronic vascular rejection ( CVR ) cases after renal transplantation and clarify the mechanisms underlying the development and prognostic significance of CVR . Patients CVR was diagnosed in 46 renal allograft biopsy specimens ( BS ) obtained from 34 renal transplant patients being followed up at the Department of Urology, T okyo Women's Medical University, between J anuary 2009 and D ecember 2013. Results CVR was diagnosed at a median of 47.4 months post‐transplant. Among the 36 patients, 23 had a history of acute rejection. Among the 46 BS showing evidence of CVR , the CVR was mild (cv1 in B anff's classification) in 23, moderate (cv2) in 17, and severe (cv3) in 6. Of the 40 samples obtained at the time of the biopsy and assayed with plastic beads coated with HLA antigen, 31 (78%) showed circulating ant‐ HLA alloantibody, and 15 (38%) showed donor‐specific antibodies. We then classified the 46 BS showing evidence of CVR by their overall histopathological features, as follows; cv alone was seen in 16 (35%) BS , cv + antibody‐mediated rejection ( AMR ) in 26 (56%), and cv + T ‐cell‐mediated rejection in 9 (19%). Loss of the renal allograft occurred during the observation period in nine of the patients (26%). Of the remaining patients with functioning grafts, deterioration of the renal allograft function after the biopsies occurred in 11 patients (32%). Conclusion The results of our study suggest that AMR may underlie CVR in many cases, while T cell‐mediated rejection may play an important role in some cases.