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Peritubular Capillaritis in Renal Allografts: Prevalence, Scoring System, Reproducibility and Clinicopathological Correlates

  1. I. W. Gibson1,*,
  2. W. Gwinner2,
  3. V. Bröcker3,
  4. B. Sis4,5,
  5. J. Riopel4,
  6. I.S.D. Roberts6,
  7. I. Scheffner2,
  8. G. S. Jhangri7,
  9. M. Mengel3,5

Article first published online: 5 FEB 2008

DOI: 10.1111/j.1600-6143.2007.02137.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 8, Issue 4, pages 819–825, April 2008

Additional Information

How to Cite

Gibson, I. W., Gwinner, W., Bröcker, V., Sis, B., Riopel, J., Roberts, I., Scheffner, I., Jhangri, G. S. and Mengel, M. (2008), Peritubular Capillaritis in Renal Allografts: Prevalence, Scoring System, Reproducibility and Clinicopathological Correlates. American Journal of Transplantation, 8: 819–825. doi: 10.1111/j.1600-6143.2007.02137.x

Author Information

  1. 1

    Department of Pathology, MS4 Health Sciences Centre, Winnipeg, Manitoba, Canada

  2. 2

    Department of Nephrology, Medizinische Hochschule Hannover, Hannover, Germany

  3. 3

    Medizinische Hochschule Hannover, Institute for Pathology, Hannover, Germany

  4. 4

    Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada

  5. 5

    Division of Nephrology & Immunology, Department of Medicine, Alberta Transplant Applied Genomics Centre, University of Alberta, Edmonton, Canada

  6. 6

    Department of Cellular Pathology, John Radcliffe Hospital, Oxford, United Kingdom

  7. 7

    Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Canada

* * Corresponding author: Ian Gibson, IGibson@exchange.hsc.mb.ca

Publication History

  1. Issue published online: 5 FEB 2008
  2. Article first published online: 5 FEB 2008
  3. Received 01 October 2007, revised 06 December 2007 and accepted for publication 11 December 2007

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Keywords:

  • Peritubular capillary;
  • rejection;
  • renal transplantation

This study of the clinico-pathological relevance and reproducibility of peritubular capillaritis in 688 renal allograft biopsies, found that scoring capillaritis is feasible and provided prognostic and diagnostic information.

While glomerulitis is graded according to the Banff classification, no criteria for scoring peritubular capillaritis (PTC) have been established. We retrospectively applied PTC-scoring criteria to 688 renal allograft (46 preimplantation, 461 protocol, 181 indication) biopsies.

A total of 26.3% of all analyzed biopsies had peritubular capillaritis (implant 0%, protocol 17.6%, indication 45.5%; p < 0.0001). The most common capillaritis pattern was of moderate severity (5–10 luminal cells), focal in extent (10–50% of PTC), with a minority of neutrophils. A total of 24% of C4d− compared with 75% of C4d+ biopsies showed capillaritis (p < 0.0001). More than 80% of biopsies with glomerulitis had peritubular capillaritis. A total of 50.4% of biopsies with borderline or T-cell mediated rejection (TCMR) and 14.1% of biopsies without TCMR or antibody-mediated rejection (ABMR) showed capillaritis (p < 0.0001). The inter-observer reproducibility of the PTC-scoring features was fair to moderate. Diffuse capillaritis detected in early protocol biopsies had significant negative prognostic impact in terms of glomerular filtration rate2 years posttransplantation. Indication biopsies show a significantly higher prevalence of capillaritis than protocol biopsies (45.5% vs. 17.6%; p < 0.0001). Capillaritis is more frequent and pronounced in ABMR, but can be observed in TCMR cases. Thus, scoring of peritubular capillaritis is feasible and can provide prognostic and diagnostic information in renal allograft biopsies.

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