title: Clinical and pathological analyses of chronic vascular rejection after kidney transplantation.
abstract: OBJECTIVE
  We discuss the clinicopathological analysis of cases of chronic vascular rejection (CVR) cases after renal transplantation and clarify the mechanisms underlying the development and prognostic significance of CVR.
  
  
  METHODS
  CVR was diagnosed in 46 renal allograft biopsy specimens (BS) obtained from 34 renal transplant patients being followed up at the Department of Urology, Tokyo Women's Medical University, between January 2009 and December 2013.
  
  
  RESULTS
  CVR was diagnosed at a median of 47.4 months post-transplant. Among the 36 patients, 23 had a history of acute rejection. Among the 46 BS showing evidence of CVR, the CVR was mild (cv1 in Banff's classification) in 23, moderate (cv2) in 17, and severe (cv3) in 6. Of the 40 samples obtained at the time of the biopsy and assayed with plastic beads coated with HLA antigen, 31 (78%) showed circulating ant-HLA alloantibody, and 15 (38%) showed donor-specific antibodies. We then classified the 46 BS showing evidence of CVR by their overall histopathological features, as follows; cv alone was seen in 16 (35%) BS, cv + antibody-mediated rejection (AMR) in 26 (56%), and cv + T-cell-mediated rejection in 9 (19%). Loss of the renal allograft occurred during the observation period in nine of the patients (26%). Of the remaining patients with functioning grafts, deterioration of the renal allograft function after the biopsies occurred in 11 patients (32%).
  
  
  CONCLUSIONS
  The results of our study suggest that AMR may underlie CVR in many cases, while T cell-mediated rejection may play an important role in some cases.
authors.affiliation: Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Toma
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Rumi
authors.initials: R
authors.lastname: Shibahara
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kuniko
authors.initials: K
authors.lastname: Tsunoyama
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Junpei
authors.initials: J
authors.lastname: Izuka
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Taiji
authors.initials: T
authors.lastname: Nozaki
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishida
authors.affiliation: Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
authors.affiliation: Department of Pathology II, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Honda
authors.affiliation: Department of Pathology, Kawasaki Municipal Tama Hospital, Kanagawa, Japan.
authors.forename: Junki
authors.initials: J
authors.lastname: Koike
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D001706:Biopsy; D002908:Chronic Disease; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology* / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood; D007668:Kidney / Q000098:blood supply / Q000187:drug effects / Q000276:immunology / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D014041:Tokyo; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000276:immunology / Q000473:pathology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies
keywords: chronic vascular rejection; neo-intima; renal transplantation