title: Reviewing the pathogenesis of antibody-mediated rejection and renal graft pathology after kidney transplantation.
abstract: The clinicopathological context of rejection after kidney transplantation was well recognized. Banff conferences greatly contributed to elucidate the pathogenesis and to establish the pathologic criteria of rejection after kidney transplantation. The most important current problem of renal transplantation is de novo donor-specific antibody (DSA) production leading chronic rejection and graft loss. Microvascular inflammation is considered as a reliable pathological marker for antibody-mediated rejection (AMR) in the presence of DSA. Electron microscopic study allowed us to evaluate early changes in peritubular capillaries in T-lymphocyte mediated rejection and transition to antibody-mediated rejection. Severe endothelial injuries with edema and activated lymphocyte invaded into subendothelial space with early multi-layering of peritubular capillary basement membrane suggest T-lymphocyte mediated rejection induce an unbounded chain of antibody-mediated rejection. The risk factors of AMR after ABO-incompatible kidney transplantation are important issues. Anti-ABO blood type antibody titre of IgG excess 32-fold before transplant operation is the only predictable factor for acute AMR. Characteristics of chronic active antibody-mediated rejection (CAAMR) are one of the most important problems. Light microscopic findings and C4d stain of peritubular capillary and glomerular capillary are useful diagnostic criteria of CAAMR. Microvascular inflammation, double contour of glomerular capillary and thickening of peritubular capillary basement are good predictive factors of the presence of de novo DSA. C4d stain of linear glomerular capillary is a more sensitive marker for CAAMR than positive C4d of peritubular capillary. Early and sensitive diagnostic attempts of diagnosing CAAMR are pivotal to prevent chronic graft failure.
authors.affiliation: Department of Nephrology and Kidney Transplantation, Masuko Memorial Hospital, Nagoya, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Morozumi
authors.affiliation: Department of Nephrology and Kidney Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Takeda
authors.affiliation: Department of Nephrology and Kidney Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Otsuka
authors.affiliation: Department of Nephrology and Kidney Transplantation, Masuko Memorial Hospital, Nagoya, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Horike
authors.affiliation: Department of Nephrology and Kidney Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Gotoh
authors.affiliation: Department of Nephrology and Kidney Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Narumi
authors.affiliation: Department of Nephrology and Kidney Transplant Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Watarai
authors.affiliation: Department of Renal Transplant Surgery, Aichi Medical University, Nagoya, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D064591:Allografts; D001706:Biopsy; D002196:Capillaries / Q000276:immunology / Q000648:ultrastructure; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology*; D006801:Humans; D056724:Immunity, Humoral; D007518:Isoantibodies / Q000276:immunology; D007668:Kidney / Q000098:blood supply / Q000276:immunology / Q000648:ultrastructure*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008854:Microscopy, Electron; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007518:Isoantibodies
keywords: antibody-mediated rejection; chronic rejection; de novo DSA; electron microscopic changes of peritubular capillaritis; kidney transplantation