Banff lesions and renal allograft survival in chronic-active antibody mediated rejection

Abstract

Aims: Chronic-active antibody mediated rejection (c-aABMR) is a major cause of kidney graft loss. Currently, little is known about the relation between histopathologic parameters and renal allograft survival. Methods and results: Between 2008 and 2014, 41 patients with a progressive decrease in renal function were diagnosed with c-aABMR according to Banff 2015 and followed up for at least 3 years. Clinical and renal biopsy characteristics were analyzed for association with graft survival. During follow-up 26 cases lost their graft because of c-aABMR at a median follow up of 40 months after diagnosis. Cases with v-lesions in their biopsy had a significant higher loss of eGFR prior to diagnosis. The total inflammation score (r = −0.45 p = .007) and the severity of interstitial fibrosis (r = −0.38 p = .023) were related to the eGFR at time of biopsy. Univariate regression analysis showed that eGFR at time of biopsy, total inflammation, interstitial fibrosis and the sum chronicity score were significantly related to the risk for graft failure during follow-up. In a multivariate analysis only the severity of interstitial fibrosis remained associated with decreased graft survival (HR 1.9 per score point, 95% CI 1.2-2.8, p = .004). Conclusion: Severity of renal interstitial fibrosis and not inflammation predicts graft survival in cases of c-aABMR.

The FCGR3A 158 V/V-Genotype is Associated With Decreased Survival of Renal Allografts With Chronic Active Antibody-Mediated Rejection

“…Before 2009, donor-speci c anti-HLA antibodies (DSA) were not routinely assessed in the period of data collection but 40% of the tested cases (N=70) were DSA positive. When histologic criteria were met, a diagnosis of c-aABMRh, termed suspicious for c-aABMR in the Banff 2015 criteria, was made in accordance with recent publications 13,14,[31][32][33] .…”

“…After diagnosis of c-aABMR progression to renal allograft failure and response to therapy is highly variable and not readily explained by clinical characteristics and Banff scores [13][14][15] . In addition, some patients have only subclinical c-aABMR, which is only detected by a protocol biopsy.…”

PSMP Is Discriminative for Chronic Active Antibody-Mediated Rejection and Associate With Intimal Arteritis in Kidney Transplantation

“…However, we require more additional data and experiments to verify this hypothesis. Intimal arteritis caused by vascular rejection has previously considered to be a feature of acute cellular rejection (1,27). In the revised 2013 Banff criteria, vascular arteritis (v > 0) was included in the diagnostic criteria for active antibody-mediated rejection (19).…”

“…Chronic active antibody-mediated rejection (CAAMR) is an intermediate process that occurs during the development of chronic antibody-mediated rejection (CAMR), which has been recognized recently. CAAMR leads to the gradual loss of allograft, becoming an obstacle to the long-term survival of renal allografts ( 1 ). Significant improvements in short-term renal graft survival have been achieved in recent decades due to the continuous updating of immunosuppressive agents, such as calcineurin inhibitors, which greatly reduce the occurrence of T cell-mediated rejection (TCMR) ( 2 ).…”

Mesangiolysis in Pathological Chronic Active Antibody-Mediated Rejection in Kidney Transplant Biopsies

“…The Banff 2015 classification suggested that pathological chronic injury and evidence of antibody interaction on the microvascular endothelium or evidence of DSA, but not both, was suspicious lesion of CAABMR [9]. In a recent study, the Banff acute and chronic pathological scores showed no difference between DSA-positive and -negative (suspicious for CAABMR in Banff 2015 classification) groups [10]. We recently defined biopsy-proven acute/active ABMR regardless of DSA positivity as "pathological" acute/active ABMR, and the acute and chronic Banff scores showed no significant difference among groups with pathological acute/ active ABMR with different levels of DSA mean fluorescence intensity [11].…”