title: 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.affiliation: 1 Medizinische Klinik mit Schwerpunkt Nephrologie, Charité Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany. 2 Institut für Pathologie, Charité Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Kaiyin
authors.initials: K
authors.lastname: Wu
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.forename: Danilo
authors.initials: D
authors.lastname: Schmidt
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: Neumayer
authors.forename: Birgit
authors.initials: B
authors.lastname: Rudolph
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001167:Arteritis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015935:Complement C4b / Q000378:metabolism; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D007668:Kidney / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d