Abstract | BACKGROUND: It is unclear if the category of acute rejection with intimal arteritis (ARV) is relevant to short- and long-term clinical outcomes and if the graft outcomes are affected by the severity of intimal arteritis. METHODS: One hundred forty-eight ARV episodes were reviewed and categorized according to the 2013 Banff criteria of AMR: T cell-mediated rejection with intimal arteritis (v) lesion (TCMRV; n = 78), total antibody-mediated rejection with v lesion (AMRV), which were further divided into suspicious AMRV (n = 37) and AMRV (n = 33). The Banff scores of intimal arteritis (v1, v2 and v3) represented low, moderate, and high ARV severity. RESULTS: The grafts with TCMRV, suspicious AMRV (sAMRV), and AMRV showed similar responses to antirejection therapy, whereas the grafts with v2- or v3-ARV responded significantly poorer compared to those with v1-ARV. The 8-year death-censored graft survival (DCGS) rate was 56.8% of TCMRV versus 34.1% of total AMRV (Log rank, P = 0.03), but the 1- and 5-year DCGS rates were comparable between the 2 groups; moreover, the 1-, 5-, and 8-year DCGS rates of v1-ARV were evidently higher than v2- and v3-ARV (each pairwise comparison to v1-AVR yields P < 0.01); in contrast, the DCGS rates were similar between sAMRV and AMRV. The existing donor-specific antibodies or moderate microvascular inflammation or C4d-positive staining or intensive tubulointerstitial inflammation played a less significant role on the long-term graft survival. CONCLUSIONS: Compared to the category, the ARV severity is more closely associated with the initial response to antirejection therapy and long-term graft failure. The sAMRV and AMRV might represent a spectrum of the same disorder.
|
Authors | Kaiyin Wu, Klemens Budde, Danilo Schmidt, Hans-Helmut Neumayer, Birgit Rudolph |
Journal | Transplantation
(Transplantation)
Vol. 99
Issue 8
Pg. e105-14
(Aug 2015)
ISSN: 1534-6080 [Electronic] United States |
PMID | 25719260
(Publication Type: Comparative Study, Journal Article)
|
Chemical References |
- Biomarkers
- Immunosuppressive Agents
- Isoantibodies
- Peptide Fragments
- Complement C4b
- complement C4d
|
Topics |
- Acute Disease
- Adult
- Aged
- Arteritis
(diagnosis, drug therapy, immunology, pathology)
- Biomarkers
(blood)
- Biopsy
- Complement C4b
(metabolism)
- Female
- Graft Rejection
(diagnosis, drug therapy, immunology, pathology)
- Graft Survival
- Humans
- Immunity, Cellular
- Immunity, Humoral
- Immunosuppressive Agents
(therapeutic use)
- Isoantibodies
(blood)
- Kidney
(immunology, pathology, physiopathology)
- Kidney Transplantation
(adverse effects)
- Male
- Middle Aged
- Peptide Fragments
(metabolism)
- Predictive Value of Tests
- Retrospective Studies
- T-Lymphocytes
(immunology)
- Time Factors
- Treatment Outcome
|