Histopathological and clinical findings in renal transplants with Banff type II and III acute cellular rejection without tubulointerstitial infiltrates

Bröcker, Verena; Hirzallah, Muhannad; Gwinner, Wilfried; Bockmeyer, Clemens L.; Wittig, Juliane; Zell, Stephanie; Agustian, Putri A.; Schwarz, Anke; Ganzenmüller, Tina; Zilian, Eva; Immenschuh, Stephan; Becker, Jan U.

doi:10.1007/s00428-013-1487-0

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…Banu Sis and colleagues presented their results during the 2013 Banff conference on allograft pathology, showing that biopsies with isolated v‐lesions are similar with regard to their response to treatment and graft survival to v‐lesions with concomitant interstitial inflammation and tubulitis, thus represent rejection . This is entirely in concordance with a recently published study comparing 23 biopsies with isolated v‐lesions with matched biopsies showing endothelialitis plus inflammation and biopsies without any evidence of rejection .…”

Section: Kidney Transplant Biopsy In Patients With Acutely Deterioratsupporting

confidence: 68%

The significance of histological diagnosis in renal allograft biopsies in 2014

Broecker

Mengel

2014

Transpl Int

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SummaryIn 2014, the renal allograft biopsy still represents the best available diagnostic 'gold' standard to assess reasons for allograft dysfunction. However, it is well recognized that histological lesion observed in the biopsy is of limited diagnostic specificity and that the Banff classification as the international diagnostic standard represents mere expert consensus. Here, we review the role of the renal allograft biopsy in different clinical and diagnostic settings. To increase diagnostic accuracy and to compensate for lack of specificity, the interpretation of biopsy pathology needs to be within the clinical context, primarily defined by time post-transplantation and patient-specific risk profile. With this in mind, similar histopathological patterns will lead to different conclusions with regard to diagnosis, disease grading and staging and thus to patient-specific clinical decision-making. Consensus generation for such integrated diagnostic approach, preferably including new molecular tools, represents the next challenge to the transplant community on its way to precision medicine in transplantation.

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Section: Kidney Transplant Biopsy In Patients With Acutely Deterioratsupporting

confidence: 68%

The significance of histological diagnosis in renal allograft biopsies in 2014

Broecker

Mengel

2014

Transpl Int

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“…Our first goal was to address whether IvL represents a particular type of allograft rejection, either ABMR or TCMR. To do so, we chose, similarly to Wu et al 8 and unlike other studies, 6,[9][10][11]13 to do the follow- year posttransplantation showed no molecular signature of rejection. 13 These findings could suggest that mechanisms different from rejection, that is, endothelial injury related to ischemia-reperfusion, may operate in some cases of IvL.…”

Section: Graft Survivalmentioning

confidence: 99%

“…4 Arterial involvement is sufficient to classify IvL as type II or III acute TCMR if pathologists rigorously comply with the instructions of the "historical" Banff scheme. 6,[8][9][10][11] Therefore, this multicentric study was conducted to thoroughly characterize the clinicopathologic phenotype of patients with IvL. 7 However, the role of the humoral immune response in the pathophysiology of IvL remains unclear, as the incidence of DSAs has not been systematically addressed in previous studies focusing on IvL.…”

Section: Introductionmentioning

confidence: 99%

“…7 However, the role of the humoral immune response in the pathophysiology of IvL remains unclear, as the incidence of DSAs has not been systematically addressed in previous studies focusing on IvL. 6,[8][9][10][11] Therefore, this multicentric study was conducted to thoroughly characterize the clinicopathologic phenotype of patients with IvL. We placed a particular emphasis on the relationship between IvL and humoral rejection.…”

Section: Introductionmentioning

confidence: 99%

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Isolated v-lesion in kidney transplant recipients: Characteristics, association with DSA, and histological follow-up

Rabant

Boullenger

Gnemmi

et al. 2018

American Journal of Transplantation

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Isolated v-lesion (IvL) represents a rare and challenging situation in renal allograft biopsies because it is unknown whether IvL truly represents rejection, antibody- or T cell-mediated, or not. This multicentric retrospective study describes the clinicopathological features of IvL with an emphasis on the donor-specific antibody (DSA) status, histological follow-up, and graft survival. Inclusion criteria were the presence of v-lesion with minimal interstitial (i ≤ 1) and microvascular inflammation (g + ptc≤1). C4d-positive biopsies were excluded. We retrospectively found 33 IvL biopsies in 33 patients, mainly performed in the early posttransplantation period (median time 27 days) and clinically indicated in 66.7%. A minority of recipients (5/33, 15.2%) had DSA at the time of biopsy. IvL was treated by anti-rejection therapy in 21 cases (63.6%), whereas 12 (36.4%) were untreated. Seventy percent of untreated patients and 66% of treated patients showed favorable histological evolution on subsequent biopsy. Kidney graft survival in IvL was significantly higher than in a matched cohort of antibody-mediated rejection with arteritis. In conclusion, IvL is not primarily antibody-mediated and may show a favorable evolution. The heterogeneity of IvL pathophysiology on early biopsies should prompt DSA testing as well as close clinical and histological follow-up in all patients with IvL.

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“…27 The interpretation of v-lesions without tubulointerstitial inflammation (i-t), isolated v-lesions, has been particularly difficult to resolve. A comparison of 23 biopsies with isolated v-lesions to 23 matched biopsies with inflammation was unable to identify significant differences 28 but underscored the concerns about ABMR.…”

mentioning

confidence: 99%

Reassessing the Significance of Intimal Arteritis in Kidney Transplant Biopsy Specimens

Salazar

Lopez

Chang

et al. 2015

Journal of the American Society of Nephrology

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Intimal arteritis (the presence of v-lesions) in kidney transplant biopsy specimens is believed to have major prognostic and diagnostic significance. We assessed the relationship of v-lesions to prognosis in 703 indication biopsy specimens and used microarray-based molecular tests to re-examine the relationship of v-lesions to rejection. v-Lesions were noted in 49 specimens (7%) and were usually mild (v1). The presence of v-lesions had no effect on graft survival compared with the absence of v-lesions. Pathologists using current conventions almost always interpreted v-lesions as reflecting T cell-mediated rejection (TCMR), either pure or mixed with antibody-mediated rejection (ABMR). The molecular scores questioned the conventional diagnoses in 29 of 49 specimens (59%), including ten that were conventional TCMR with no molecular rejection and nine that were conventional TCMR mixed with pure ABMR molecularly. The presence of tubulointerstitial inflammation (i-t) meeting TCMR criteria allowed subclassification of v-lesion specimens into 21 i-t-v-lesion specimens and 28 isolated v-lesion specimens. Molecular TCMR scores were positive in 95% of i-t-v-lesion specimens but only 21% of isolated v-lesion specimens. Molecular ABMR scores were often positive in isolated v-lesion biopsies (46%). Time of biopsy after transplantation was critical for understanding isolated v-lesions: most early isolated v-lesion specimens had no molecular rejection and were DSA negative, whereas most isolated .1 year after transplantation had positive DSA and ABMR scores. Therefore, v-lesions in indication biopsy specimens do not affect prognosis and can reflect TCMR, ABMR, or no rejection. Time after transplantation, DSA, and accompanying inflammation provide probabilistic basis for interpreting v-lesions.

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Histopathological and clinical findings in renal transplants with Banff type II and III acute cellular rejection without tubulointerstitial infiltrates

Cited by 7 publications

References 22 publications

The significance of histological diagnosis in renal allograft biopsies in 2014

The significance of histological diagnosis in renal allograft biopsies in 2014

Isolated v-lesion in kidney transplant recipients: Characteristics, association with DSA, and histological follow-up

Reassessing the Significance of Intimal Arteritis in Kidney Transplant Biopsy Specimens

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