Clinicopathologic analysis of acute vascular rejection cases after renal transplantation.
BACKGROUND
Histopathologic change of acute vascular rejection (AVR) is characterized by intimal arteritis and transmural arteritis. In this report, we discuss the clinicopathologic analysis of AVR cases after renal transplantation.


METHODS
AVR was diagnosed in 28 renal transplant recipients followed up in our institute between January 2003 and November 2010.


RESULTS
Among 28 cases of AVR, 18 were mild (v1 in Banff 07 classification), 8 were moderate (v2), and 2 were severe (v3). Interstitial inflammation was present in 25 biopsy specimens. Moderate to severe tubulitis (t2-t3) was present in 10 biopsy specimens and transplant glomerulitis in 17; peritubular capillaritis was in 25 of the 28 biopsy specimens. C4d deposition in peritubular capillaries was observed in 11/28 cases. By using assays with plastic beads coated with human leukocyte antigen (HLA) in the 28 cases, we detected circulating anti-HLA alloantibody in 18 patients, among which 11/28 were donor-specific. Acute antibody-mediated rejection was diagnosed in 6 cases. Among AVR cases, 19/28 displayed steroid-resistant rejection (SRR) requiring greater anti-rejection therapy (ART), including muromonab CD3 injection, gusperimus injections, plasmapheresis, intravenous immune globulin, and/or rituximab injections. Twenty of 28 patients recovered renal allograft function after ART, and 26/28 grafts are functioning. Among the 2 cases of graft loss, only 1 patient lost his graft due to AVR.


CONCLUSIONS
In some cases, AVR might be provoked by anti-donor antibodies. The prognosis of the graft exhibiting AVR was relatively good using available immunosuppression.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
T
T
Shimizu
T
T
Tanabe
K
K
Omoto
H
H
Ishida
K
K
Tanabe
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001167:Arteritis / Q000097:blood / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015935:Complement C4b / Q000032:analysis; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006085:Graft Survival / Q000187:drug effects; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D007564:Japan; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000098:blood supply* / Q000187:drug effects / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D010956:Plasmapheresis; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d; D003404:Creatinine