Isolated v-lesion in kidney transplant recipients: Characteristics, association with DSA, and histological follow-up
| Autor: | Gaëlle Pellé, Viviane Gnemmi, Marion Rabant, Dany Anglicheau, Alexandre Hertig, David Buob, Jean-Paul Duong Van Huyen, Caroline Suberbielle, François Glowacki, Jean-Luc Taupin, Fanny Boullenger, Isabelle Brocheriou, Christophe Legendre |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Biopsy 030232 urology & nephrology Renal function 030230 surgery Kidney Function Tests Gastroenterology Lesion 03 medical and health sciences Young Adult 0302 clinical medicine Isoantibodies Risk Factors Internal medicine Immunology and Allergy Medicine Humans Pharmacology (medical) Arteritis Young adult Aged Retrospective Studies Transplantation Kidney medicine.diagnostic_test business.industry Graft Survival Retrospective cohort study Middle Aged medicine.disease Prognosis Kidney Transplantation Pathophysiology Tissue Donors Transplant Recipients medicine.anatomical_structure Kidney Failure Chronic Female medicine.symptom business Follow-Up Studies Glomerular Filtration Rate |
| Zdroj: | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 18(4) |
| ISSN: | 1600-6143 |
| Popis: | Isolated v-lesion (IvL) represents a rare and challenging situation in renal allograft biopsies because it is unknown whether IvL truly represents rejection, antibody- or T cell-mediated, or not. This multicentric retrospective study describes the clinicopathological features of IvL with an emphasis on the donor-specific antibody (DSA) status, histological follow-up, and graft survival. Inclusion criteria were the presence of v-lesion with minimal interstitial (i ≤ 1) and microvascular inflammation (g + ptc≤1). C4d-positive biopsies were excluded. We retrospectively found 33 IvL biopsies in 33 patients, mainly performed in the early posttransplantation period (median time 27 days) and clinically indicated in 66.7%. A minority of recipients (5/33, 15.2%) had DSA at the time of biopsy. IvL was treated by anti-rejection therapy in 21 cases (63.6%), whereas 12 (36.4%) were untreated. Seventy percent of untreated patients and 66% of treated patients showed favorable histological evolution on subsequent biopsy. Kidney graft survival in IvL was significantly higher than in a matched cohort of antibody-mediated rejection with arteritis. In conclusion, IvL is not primarily antibody-mediated and may show a favorable evolution. The heterogeneity of IvL pathophysiology on early biopsies should prompt DSA testing as well as close clinical and histological follow-up in all patients with IvL. |
| Databáze: | OpenAIRE |
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