Subclinical peritubular capillaritis at 3 months is associated with chronic rejection at 1 year.
ABSTRACT Peritubular capillaritis has been associated with chronic rejection, but the characteristics of subclinical lesions in peritubular capillaries are unknown.
Fifty-three renal allograft recipients underwent a protocol biopsy at both 3 and 12 months after transplantation. Subclinical chronic antibody-mediated rejection (CAMR) at 1 year was diagnosed when three or more of five criteria were present: basement membrane multilayering of peritubular capillaries (MLPTC), transplant glomerulopathy, increase in intimal fibrosis between 3 and 12 months, C4d deposition in peritubular capillaries, and the presence of anti-human leukocyte antigen antibodies.
Six (11.3%) patients met the criteria of CAMR. MLPTC was the most sensitive (83.3%) and specific (89.1%) histological criterion (P=0.0008). Five patients had peritubular capillaritis at their 3-month biopsy. They all developed MLPTC at 1 year (P<0.0001). Three of the patients with early peritubular capillaritis met the criteria of CAMR at 1 year (P=0.0002).
Through early detection of subclinical peritubular capillaritis, renal allograft recipients who are at risk for development of MLPTC might be identified. Larger series are needed to confirm these preliminary findings, but this report suggests peritubular capillaritis as an early detection marker for patients at risk for CAMR.
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ABSTRACT: The 9th Banff Conference on Allograft Pathology was held in La Coruna, Spain on June 23-29, 2007. A total of 235 pathologists, clinicians and scientists met to address unsolved issues in transplantation and adapt the Banff schema for renal allograft rejection in response to emerging data and technologies. The outcome of the consensus discussions on renal pathology is provided in this article. Major updates from the 2007 Banff Conference were: inclusion of peritubular capillaritis grading, C4d scoring, interpretation of C4d deposition without morphological evidence of active rejection, application of the Banff criteria to zero-time and protocol biopsies and introduction of a new scoring for total interstitial inflammation (ti-score). In addition, emerging research data led to the establishment of collaborative working groups addressing issues like isolated 'v' lesion and incorporation of omics-technologies, paving the way for future combination of graft biopsy and molecular parameters within the Banff process.American Journal of Transplantation 05/2008; 8(4):753-60. · 6.39 Impact Factor
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ABSTRACT: We describe the molecular and cellular mechanisms believed to be responsible for the rejection of renal allografts, including acute T cell-mediated rejection, acute antibody-mediated (humoral) rejection, rejection mediated by the innate immune system, and chronic rejection. We present mechanisms of graft acceptance, including accommodation, regulation, and tolerance. Studies in animals have replicated many pathologic features of acute and chronic rejection. We illuminate the pathogenesis of human pathology by reflection from experimental models.Annual Review of Pathology Mechanisms of Disease 02/2008; 3:189-220. · 20.00 Impact Factor