title: Histopathological and clinical findings in renal transplants with Banff type II and III acute cellular rejection without tubulointerstitial infiltrates.
abstract: According to the Banff guidelines for renal transplants, pure endothelialitis without any tubulointerstitial infiltrates (with the Banff components v ≥ 1, i0, t0) has to be called acute cellular rejection (ACR). The pathophysiology of this rare lesion abbreviated as v_only is currently unclear, as well as its clinical, serological, and prognostic implications. Therefore, we conducted this retrospective comparative study. We compared all 23 biopsies with v_only from Hannover Medical School between 2003 and 2010 with 23 matched biopsies with the Banff components v ≥ 1, i ≥ 1, and t ≥ 1 (v_plus) and 23 biopsies with v0, i0, and t0 (v0i0t0). Serological (available in 10, 11, and 14 patients, respectively), histological, and clinical data were compared. Of all biopsies, 0.4 % had findings of v_only. v_only, v_plus, and v0i0t0 only showed minimal differences in the Banff components apart from the cohort-defining components. Endothelialitis in v_only more frequently involved the arcuate arteries than the smaller preglomerular vessels compared to v_plus and vice versa. Combining histopathological data and serological data, v_only more frequently showed criteria for acute humoral rejection than v0i0t0 (albeit not persistent after the Bonferroni-Holm correction in pairwise comparisons), while there was no difference between v_only and v_plus. No difference could be demonstrated regarding clinical presentation at biopsy or outcome. Our results show minimal differences regarding clinical presentation, outcome, and histological features between v_only and v_plus. Patients with v_only should be thoroughly investigated for evidence of acute humoral rejection.
authors.affiliation: Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Bröcker
authors.forename: Muhannad
authors.initials: M
authors.lastname: Hirzallah
authors.forename: Wilfried
authors.initials: W
authors.lastname: Gwinner
authors.forename: Clemens Luitpold
authors.initials: CL
authors.lastname: Bockmeyer
authors.forename: Juliane
authors.initials: J
authors.lastname: Wittig
authors.forename: Stephanie
authors.initials: S
authors.lastname: Zell
authors.forename: Putri Andina
authors.initials: PA
authors.lastname: Agustian
authors.forename: Anke
authors.initials: A
authors.lastname: Schwarz
authors.forename: Tina
authors.initials: T
authors.lastname: Ganzenmüller
authors.forename: Eva
authors.initials: E
authors.lastname: Zilian
authors.forename: Stephan
authors.initials: S
authors.lastname: Immenschuh
authors.forename: Jan Ulrich
authors.initials: JU
authors.lastname: Becker
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000473:pathology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous