• Please log in or register to access this feature.

Brief Communication

Microcirculation Inflammation Associates With Outcome in Renal Transplant Patients With De Novo Donor-Specific Antibodies

  1. H. de Kort1,
  2. M. Willicombe2,
  3. P. Brookes3,
  4. K. M. Dominy1,
  5. E. Santos-Nunez3,
  6. J. W. Galliford2,
  7. K. Chan2,
  8. D. Taube2,
  9. A. G. McLean2,
  10. H. T. Cook1,
  11. C. Roufosse1,*

Article first published online: 21 NOV 2012

DOI: 10.1111/j.1600-6143.2012.04325.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 13, Issue 2, pages 485–492, February 2013

Additional Information

How to Cite

de Kort, H., Willicombe, M., Brookes, P., Dominy, K. M., Santos-Nunez, E., Galliford, J. W., Chan, K., Taube, D., McLean, A. G., Cook, H. T. and Roufosse, C. (2013), Microcirculation Inflammation Associates With Outcome in Renal Transplant Patients With De Novo Donor-Specific Antibodies. American Journal of Transplantation, 13: 485–492. doi: 10.1111/j.1600-6143.2012.04325.x

Author Information

  1. 1

    Department of Histopathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK

  2. 2

    Imperial College Kidney and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK

  3. 3

    Histocompatibility and Immunogenetics Laboratory, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK

*Corresponding author: Candice Roufosse, Candice.Roufosse@imperial.nhs.uk

Publication History

  1. Issue published online: 28 JAN 2013
  2. Article first published online: 21 NOV 2012
  3. Manuscript Accepted: 27 SEP 2012
  4. Manuscript Revised: 11 SEP 2012
  5. Manuscript Received: 31 MAY 2012

Funded by

  • European Renal Association—European Dialysis
  • Transplant Association (ERA/EDTA)
  • NIHR Biomedical Research Centre

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (850K)

Keywords:

  • Antibody-mediated rejection;
  • C4d;
  • donor-specific antibodies;
  • histopathology;
  • microcirculation inflammation;
  • renal transplantation

In renal transplant patients with de novo donor-specific antibodies (dnDSA) we studied the value of microcirculation inflammation (MI; defined by the addition of glomerulitis (g) and peritubular capillaritis (ptc) scores) to assess long-term graft survival in a retrospective cohort study. Out of all transplant patients with standard immunological risk (n = 638), 79 (12.4%) developed dnDSA and 58/79 (73%) had an indication biopsy at or after dnDSA development. Based on the MI score on that indication biopsy patients were categorized, MI0 (n = 26), MI1 + 2 (n = 21) and MI ≥ 3 (n = 11). The MI groups did not differ significantly pretransplantation, whereas posttransplantation higher MI scores developed more anti-HLA class I + II DSA (p = 0.011), showed more TCMR (p < 0.001) and showed a trend to C4d-positive staining (p = 0.059). Four-year graft survival estimates from time of indication biopsy were MI0 96.1%, MI1 + 2 76.1% and MI ≥ 3 17.1%; resulting in a 24-fold increased risk of graft failure in the MI ≥ 3 compared to the MI0 group (p = 0.003; 95% CI [3.0–196.0]). When adjusted for C4d, MI ≥ 3 still had a 21-fold increased risk of graft failure (p = 0.005; 95% CI [2.5–180.0]), while C4d positivity on indication biopsy lost significance. In renal transplant patients with de novo DSA, microcirculation inflammation, defined by g + ptc, associates with graft survival.

View Full Article (HTML) Get PDF (850K)