The Pathological and Clinical Diversity of Acute Vascular Rejection in Kidney Transplantation

Nankivell, Brian J.; Shingde, Meena; P’ng, Chow Heok

doi:10.1097/tp.0000000000004071

Cited by 4 publications

(4 citation statements)

References 38 publications

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“…Similarly, Nankivell's group argue that arterial C4d deposition by immunohistochemistry is indicative of antibody interaction to graft endothelium in vascular rejection. This correlated with circulating DSA, Banff mi, Banff C4d, and graft outcomes [5]. In our experience, C4d can also be found in the intima in native kidneys with arteriosclerosis.…”

Section: Pathologic Features and Outcomessupporting

confidence: 74%

Histologic and molecular features of antibody-mediated rejection

Rosales

Smith

Colvin

2023

Current Opinion in Organ Transplantation

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Purpose of review This review aims to summarize the highlights from recent research that involved pathological and molecular analysis of kidney allografts. Recent findings As the research on antibody-mediated rejection (AMR) continues to evolve, studies are focused on identification through transcript studies of pathogenetic pathways involved in the development of AMR as well as refinement of diagnostic methods either by correlating Banff pathologic lesions with clinical and molecular data or by machine learning. Of note, the past year has generated high impact research that underscore the importance of pathologic and molecular correlations and detection of transcripts or gene sets that would aid prognostication. The studies involving refinement of pathologic criteria also highlight the continuous efforts to achieve diagnostic accuracy and standardization. Summary Research involving histologic and molecular characteristics that define AMR are central to identification and understanding of pathogenetic pathways and remain critical in the development of diagnostic criteria.

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Section: Pathologic Features and Outcomessupporting

confidence: 74%

Histologic and molecular features of antibody-mediated rejection

Rosales

Smith

Colvin

2023

Current Opinion in Organ Transplantation

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“…Most recently, Nankivell et al evaluated 100 biopsies with arteritis compared with cases with either acute rejection with v = 0 (positive controls) or no/minimal inflammation (negative controls). 77 Diagnoses in the arteritis cases included acute TCMR (43), AMR (21), and mixed (36). Arteritis occurred within 1 mo in 54%, in which it was associated with acute dysfunction and a better response to treatment.…”

Section: Vasculitis and Banff-vmentioning

confidence: 99%

“…74,75 Furthermore, arteritis can also be found with BL lesions, 74 AMR, 76 and mixed AMR/TCMR rejections 77 and as an isolated lesion without other inflammation. 74,77,78 Since Banff 2009, there are 4 categories of arteritis (v >0): grades IIA, IIB, and III TCMRs and as a defining feature of tissue injury of AMR.…”

Section: Vasculitis and Banff-vmentioning

confidence: 99%

“…However, microarray analyses found minimal T cell transcriptional activity in some cases with arteritis, a result suggesting that it may not represent acute TCMR 73 or even rejection at all. 74,75 Furthermore, arteritis can also be found with BL lesions, 74 AMR, 76 and mixed AMR/TCMR rejections 77 and as an isolated lesion without other inflammation. 74,77,78 Since Banff 2009, there are 4 categories of arteritis (v >0): grades IIA, IIB, and III TCMRs and as a defining feature of tissue injury of AMR.…”

Section: Vasculitis and Banff-vmentioning

confidence: 99%

See 1 more Smart Citation

The Histological Spectrum and Clinical Significance of T Cell–mediated Rejection of Kidney Allografts

Filippone

Farber

2022

Transplantation

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T cell-mediated rejection (TCMR) remains a significant cause of long-term kidney allograft loss, either indirectly through induction of donor-specific anti-HLA alloantibodies or directly through chronic active TCMR. Whether found by indication or protocol biopsy, Banff defined acute TCMR should be treated with antirejection therapy and maximized maintenance immunosuppression. Neither isolated interstitial inflammation in the absence of tubulitis nor isolated tubulitis in the absence of interstitial inflammation results in adverse outcomes, and neither requires antirejection treatment. RNA gene expression analysis of biopsy material may supplement conventional histology, especially in ambiguous cases. Lesser degrees of tubular and interstitial inflammation (Banff borderline) may portend adverse outcomes and should be treated when found on an indication biopsy. Borderline lesions on protocol biopsies may resolve spontaneously but require close follow-up if untreated. Following antirejection therapy of acute TCMR, surveillance protocol biopsies should be considered. Minimally invasive blood-borne assays (donor-derived cell-free DNA and gene expression profiling) are being increasingly studied as a means of following stable patients in lieu of biopsy. The clinical benefit and cost-effectiveness require confirmation in randomized controlled trials. Treatment of acute TCMR is not standardized but involves bolus corticosteroids with lymphocyte depleting antibodies for severe, refractory, or relapsing cases. Arteritis may be found with acute TCMR, active antibody-mediated rejection, or mixed rejections and should be treated accordingly. The optimal treatment ofchronic active TCMR is uncertain. Randomized controlled trials are necessary to optimally define therapy.

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