title: Antibody-Mediated Acute Vascular Rejection of Kidney Allografts: Fifteen-Year Follow-up.
abstract: BACKGROUND
  Although acute vascular rejection (AVR) is associated with a high risk of graft loss, it remains unclear whether AVR with accompanied cellular or humoral rejection (AHR) has dissimilar outcomes. The aim of this study was to examine the association between subtypes of AVR and graft loss.
  
  
  METHODS
  We assessed patients who provided biopsy samples for acute allograft rejection from 1998 to 2014. To investigate distinct rejection patterns, we retrospectively assessed rejection episodes with review of graft histology as well as donor-specific anti-HLA antibodies when available.
  
  
  RESULTS
  A total of 1,004 patients were biopsied and included in the main analyses, of which 259 (32.87%) had acute biopsy-proven rejection. We identified three patterns of graft rejection defined according to the presence of peritubular capillaritis (ptc): a) T-cell-mediated acute vascular rejection if ptc free; b) humoral-mediated acute vascular rejection if ptc >0; and c) T-cell-mediated rejection if vasculitis = 0 and ptc = 0 (148 [57%], 70 [27%], and 41 [16%], respectively). At 5 years, graft survival was lower among patients with ptc-vascular rejection than those with T-cell vascular rejection (72.3% vs 83.2%; P = .010). T-cell-mediated rejection without vasculitis had similar survival compared with rejection absence (89.3% vs 8 9.2%; P = .698). Multivariate analysis adjusted by age and sex showed that risk of graft loss was higher in biopsies with high scores of glomerulitis (g2-g3); vasculitis (v2-v3), capillaritis (ptc2-ptc3), or interstitial inflammation (i2-i3). However, tubulitis and C4d were not statically significant.
  
  
  CONCLUSIONS
  We conclude that antibody-mediated AVR involves a poorer prognosis than T-cell-mediated AVR. The presence of tubulitis does not seem to determine a poor long-term renal graft prognosis.
authors.affiliation: Nephrology, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: brcubillo@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Rodríguez Cubillo
authors.affiliation: Nephrology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Pérez Flores
authors.affiliation: Nephrology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Calvo
authors.affiliation: Nephrology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pascual
authors.affiliation: Nephrology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Cortés
authors.affiliation: Nephrology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Moreno
authors.affiliation: Nephrology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Blanco
authors.affiliation: Nephrology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sánchez Fructuoso
mesh_terms: D000328:Adult; D064591:Allografts / Q000473:pathology*; D000906:Antibodies / Q000276:immunology*; D001706:Biopsy; D002196:Capillaries / Q000473:pathology; D015935:Complement C4b / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000276:immunology / Q000473:pathology; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000473:pathology; D014184:Transplantation, Homologous; D014657:Vasculitis / Q000276:immunology / Q000473:pathology
chemical_list: D000906:Antibodies; D015935:Complement C4b