title: Morphologic Features and Clinical Impact of Arteritis Concurrent with Transplant Glomerulopathy.
abstract: Little is known about the morphology and clinical relevance of arteritis in renal allograft biopsies with transplant glomerulopathy. We retrospectively reviewed the morphologic findings and clinical course of 59 patients with cg, 16 of which featured concurrent arteritis (fibrosing intimal arteritis with luminal narrowing in 15, and acute intimal arteritis in 1 case). Fifteen out of the 16 cases with arteritis fulfilled the morphological diagnostic criteria for chronic active antibody-mediated rejection, and 11 cases with arteritis showed morphological evidence of concurrent, ongoing T-cell-mediated alloimmune response (acute T-cell-mediated rejection in 5, borderline changes in 6 cases). Further, the Banff grades of interstitial inflammation in scarred and nonscarred cortex, total cortical inflammation, and arterial luminal narrowing were significantly higher in biopsies with arteritis. By immunohistochemistry, T-lymphocyte predominance over macrophages was found in the intimal infiltrates in 14 out of 16 cases, and cytotoxic T-lymphocytes were identified among intimal mononuclears in 10 cases. Patients with arteritis demonstrated a significantly shorter renal survival (7.5 vs. 29 months). In conclusion, T-cell-mediated mechanisms could play a role in the development of arteritis concurrent with cg. However, this finding does not exclude the possibility that antibody-mediated rejection can also contribute to the evolution of the lesion. Importantly, the lesion carries negative prognostic value likely via severe arterial luminal narrowing.
authors.affiliation: Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary. dobi.dejan@gmail.com.
authors.forename: Deján
authors.initials: D
authors.lastname: Dobi
authors.affiliation: Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Bodó
authors.affiliation: Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary.
authors.forename: Éva
authors.initials: É
authors.lastname: Kemény
authors.affiliation: Department of Medical Physics and Informatics, University of Szeged, Koranyi fasor 9., H-6720, Szeged, Hungary.
authors.forename: Krisztina
authors.initials: K
authors.lastname: Boda
authors.affiliation: Department of Surgery, University of Szeged, Szokefalvi-Nagy u. 6., H-6720, Szeged, Hungary.
authors.forename: Pál
authors.initials: P
authors.lastname: Szenohradszky
authors.affiliation: Department of Surgery, University of Szeged, Szokefalvi-Nagy u. 6., H-6720, Szeged, Hungary.
authors.forename: Edit
authors.initials: E
authors.lastname: Szederkényi
authors.affiliation: Department of Pathology, University of California, San Francisco, 513 Parnassus Avenue, Room S566, San Francisco, CA, 94143-0102, USA.
authors.forename: Zoltan G
authors.initials: ZG
authors.lastname: Laszik
authors.affiliation: Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Iványi
mesh_terms: D000328:Adult; D001167:Arteritis / Q000209:etiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000209:etiology / Q000473:pathology*; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016130:Immunophenotyping; D007249:Inflammation / Q000209:etiology / Q000473:pathology*; D007674:Kidney Diseases / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000473:pathology
keywords: Arteritis; Chronic antibody-mediated rejection; Graft survival; Kidney allograft; T-cell-mediated rejection