title: Comparing transplant glomerulopathy in the absence of C4d deposition and donor-specific antibodies to chronic antibody-mediated rejection.
abstract: BACKGROUND
  Transplant glomerulopathy (TG) is the characteristic lesion of chronic antibody-mediated rejection (AMR). However, in some patients presents with no circulating HLA antibodies or C4d positivity.
  
  
  OBJECTIVE
  Patients with TG accomplishing criteria for chronic AMR were compared to patients with isolated TG.
  
  
  METHODS
  We reviewed late (>6 months) graft biopsies performed between 2007 and 2010 (n = 75). Biopsies with C4d-negative TG and no circulating donor-specific antibody were called isolated TG (n = 12), and chronic AMR was defined according to Banff consensus (n = 17). HLA antibodies were evaluated by Luminex technology. Immunohistochemistry was performed to quantify graft infiltrating cells.
  
  
  RESULTS
  Patients with isolated TG were older (52 ± 14 vs. 35 ± 14; p = 0.0048), received grafts from older donors (54 ± 16 vs. 41 ± 18; p = 0.0554), and displayed a lower inflammation in the glomerular (g-score: 0.5 ± 0.5 vs. 1.0 ± 0.9; p = 0.0865; CD3 positive cells/glomeruli: 1.5 ± 2.9 vs. 4.4 ± 4.1; p = 0.0147), interstitial (i-score: 1.2 ± 0.9 vs. 1.9 ± 1.0; p = 0.0685; CD45 positive cells/hpf: 18 ± 11 vs. 57 ± 68; p = 0.0132), and peritubular capillary (ptc-score 0.2 ± 0.6 vs. 1.1 ± 0.9; p = 0.0089; CD45 positive cells/hpf: 3.7 ± 3.1 vs. 10.1 ± 7.4; p = 0.0290) compartments. Fifteen grafts were lost and graft survival was significantly lower in patients with chronic AMR (p = 0.0122).
  
  
  CONCLUSIONS
  Isolated TG is associated with less severe allograft inflammation and with a better outcome than chronic AMR.
authors.affiliation: Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Irina B
authors.initials: IB
authors.lastname: Torres
authors.forename: Maite
authors.initials: M
authors.lastname: Salcedo
authors.forename: Francesc
authors.initials: F
authors.lastname: Moreso
authors.forename: Joana
authors.initials: J
authors.lastname: Sellarés
authors.forename: Eva
authors.initials: E
authors.lastname: Castellá
authors.forename: M Antonieta
authors.initials: MA
authors.lastname: Azancot
authors.forename: Manel
authors.initials: M
authors.lastname: Perelló
authors.forename: Carme
authors.initials: C
authors.lastname: Cantarell
authors.forename: Daniel
authors.initials: D
authors.lastname: Serón
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000401:mortality*; D015935:Complement C4b / Q000276:immunology*; D005260:Female; D005455:Fluorescent Antibody Technique; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000276:immunology*; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007124:Immunoenzyme Techniques; D007518:Isoantibodies / Q000276:immunology*; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000401:mortality / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000276:immunology*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d
keywords: chronic antibody-mediated rejection; donor-specific antibodies; transplant glomerulopathy