title: Re-evaluation of glomerulitis using occlusion criteria based on the Banff 2013 revision: a retrospective study.
abstract: The presence of occlusion/near-occlusion of glomerular capillaries was recently added to the existing definition of glomerulitis (g). We retrospectively re-evaluated 135 renal allograft biopsies regarding g to ensure no antibody-damaged grafts were missed. Previous and revised g scores (pg and rg, respectively) were compared for clinicopathologic correlations. The g score did not change in 100 (74.1%) biopsies. Thirty-five (25.9%) biopsies were changed to a lower score. Sensitivity and specificity of pg and rg for the presence of donor-specific antibodies (DSA) were 76% vs. 58% and 70% vs. 79%, respectively. Pg score indicated graft loss with 65% sensitivity and 63% specificity, whereas rg showed 46% sensitivity and 71% specificity. Area under the curve (AUC) values in ROC analysis for DSA and graft loss were as follows: pg, 0.773; rg, 0.693; and pg, 0.635; rg, 0.577, respectively. A comparison of the two AUC values revealed a significant difference between pg and rg only for DSA (P = 0.0076). Pg and post-transplant time of biopsy independently predicted graft loss, whereas rg did not. In conclusion, revised g scores showed lesser sensitivity but higher specificity for DSA and graft loss. Recent definition of g missed antibody-mediated rejection in few cases, and it was not an independent predictor for graft loss.
authors.affiliation: Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Yasemin
authors.identifier: http://orcid.org/0000-0002-7191-0488
authors.initials: Y
authors.lastname: Ozluk
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Caliskan
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sevinc
authors.affiliation: Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Aysel
authors.initials: A
authors.lastname: Bayram
authors.affiliation: Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Evsen A
authors.initials: EA
authors.lastname: Arikan
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Aydin
authors.initials: A
authors.lastname: Turkmen
authors.affiliation: Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Sebahat
authors.initials: S
authors.lastname: Akgul
authors.affiliation: Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Fatma O
authors.initials: FO
authors.lastname: Savran
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Mehmet S
authors.initials: MS
authors.lastname: Sever
authors.affiliation: Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Isin
authors.initials: I
authors.lastname: Kilicaslan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000918:Antibody Specificity; D001706:Biopsy; D002196:Capillaries / Q000473:pathology; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D006085:Graft Survival; D006801:Humans; D007518:Isoantibodies / Q000378:metabolism; D007678:Kidney Glomerulus / Q000098:blood supply / Q000276:immunology / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D007518:Isoantibodies
keywords: Banff classification; biopsy; glomerulitis; renal transplant