2013
DOI: 10.1111/j.1600-6143.2012.04325.x
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Microcirculation Inflammation Associates With Outcome in Renal Transplant Patients With De Novo Donor-Specific Antibodies

Abstract: In renal transplant patients with de novo donorspecific antibodies (dnDSA) we studied the value of microcirculation inflammation (MI; defined by the addition of glomerulitis (g) and peritubular capillaritis (ptc) scores) to assess long-term graft survival in a retrospective cohort study. Out of all transplant patients with standard immunological risk (n = 638), 79 (12.4%) developed dnDSA and 58/79 (73%) had an indication biopsy at or after dnDSA development. Based on the MI score on that indication biopsy pati… Show more

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Cited by 96 publications
(63 citation statements)
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“…Notably, in these initial studies, the worst outcome results were reported for C4d+ allografts, suggesting that C4d could indicate a more severe form of ABMR (8,31). However, this concept was questioned by subsequent reports suggesting a strong independent clinical effect of microcirculation injury (11,32,33). Nevertheless, comparably small sample sizes in many of the cited studies may have impeded the strength of multivariable statistical models.…”
Section: Discussionmentioning
confidence: 88%
“…Notably, in these initial studies, the worst outcome results were reported for C4d+ allografts, suggesting that C4d could indicate a more severe form of ABMR (8,31). However, this concept was questioned by subsequent reports suggesting a strong independent clinical effect of microcirculation injury (11,32,33). Nevertheless, comparably small sample sizes in many of the cited studies may have impeded the strength of multivariable statistical models.…”
Section: Discussionmentioning
confidence: 88%
“…In renal transplantation, peritubular endothelial damage, in particular endothelial C4d staining, reflects rejection (213). Endothelial inflammation is a crucial component of rejection in renal transplants and predicts graft outcomes (214,215). Experimentally, depletion of monocytes prevented capillary rarefaction (216), demonstrating the importance of interactions between inflammatory cells and the renal endothelium.…”
Section: The Role Of Interstitial Mesenchymal Cellsmentioning
confidence: 99%
“…113 Cumulative prevalence at 3 years post-transplant is similarly varied from 6% 116 to 38%, 113 with lifetime cumulative prevalence even more disparate. Class II antibodies predominate in most [115][116][117][118][119][120][121][122][123][124][125] but not all reports. [111][112][113][114] With differences in antibody MFI cutoffs, baseline immunosuppression, and frequency of testing, definitive conclusions remain elusive.…”
Section: Utility Of Hla Antibody Testing Pretransplantmentioning
confidence: 99%