title: Histopathologic features of transplant glomerulopathy associated with response to therapy with intravenous immune globulin and rituximab.
abstract: Transplant glomerulopathy (TG) is associated with poor long-term allograft survival and is often accompanied by microcirculation inflammation. Histopathologic scoring may inform prognosis and help guide therapy. We retrospectively assessed 33 patients with biopsy-proven TG. All biopsies were given a glomerulitis (g) and peritubular capillaritis (ptc) score. We determined allograft survival and serum creatinine stability in three different score groups: g < 2 and ≥ 2, ptc < 2 and ≥ 2, and (g + ptc) < 4 and ≥ 4. We assessed the impact of treatment with intravenous immune globulin (IVIG) and rituximab on outcomes. Graft survival and serum creatinine stability did not differ in each of the histopathologic score groups. Higher-score groups were associated with the presence of concomitant antibody-mediated rejection and were more likely to receive IVIG and rituximab. Treatment with IVIG and rituximab resulted in stability of serum creatinine within the higher-score groups, but not in the lower-score groups. Stabilization of serum creatinine was associated with an improvement in donor-specific antibody. Histopathologic scoring in kidney allograft biopsies with TG may help guide treatment. The combination of IVIG and rituximab appears to be beneficial in patients whose biopsies have moderate or severe microvascular injury.
authors.affiliation: Kidney and Pancreas Transplant Program, Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kahwaji
authors.forename: Reiad
authors.initials: R
authors.lastname: Najjar
authors.forename: Deepika
authors.initials: D
authors.lastname: Kancherla
authors.forename: Rafael
authors.initials: R
authors.lastname: Villicana
authors.forename: Alice
authors.initials: A
authors.lastname: Peng
authors.forename: Stanley
authors.initials: S
authors.lastname: Jordan
authors.forename: Ashley
authors.initials: A
authors.lastname: Vo
authors.forename: Mark
authors.initials: M
authors.lastname: Haas
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000209:etiology / Q000473:pathology*; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage; D007249:Inflammation / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D007674:Kidney Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D015996:Survival Rate; D014184:Transplantation, Homologous
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D000069283:Rituximab
keywords: antibodies; desensitization; kidney transplant; outcomes; pathology; rejection