The Relationship of the Severity and Category of Acute Rejection With Intimal Arteritis Defined in Banff Classification to Clinical Outcomes.

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