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Rejection of the Renal Allograft in the Absence of Demonstrable Antibody and Complement.
Transplantation. 2017 02; 101(2):395-401.T

Abstract

BACKGROUND

Recent literature has stressed the prominent role of antibodies in graft loss. This study was designed to assess a growing perception that T cell-mediated rejection (TCMR) is no longer clinically relevant.

METHODS

Five hundred forty-five renal allograft recipients over a 3-year period were screened for biopsies with: (a) TCMR including borderline change (BL), (b) negative complement protein C4 degradation fragment, and (c) absence of donor-specific antibody at time of transplant, within 30 days of the biopsy, and up to 4 measurements at later time points.

RESULTS

These stringent requirements identified 28 "pure" cases of late TCMR/BL. Low-grade glomerulitis, peritubular capillaritis, or chronic transplant glomerulopathy were found in 9/28 (32%) biopsies. Serum creatinine showed complete short-term remission in 7/10 (70%) BL and 9/18 (50%) TCMR patients 1 month postbiopsy. Yet, both treated and untreated patients demonstrated further decline in graft function as assessed by serum creatinine and estimated glomerular filtration rate.

CONCLUSIONS

Late TCMR seen in 7.9% of biopsies can contribute to significant deterioration of graft function in patients in whom the dominant contribution of antibody-mediated injury has been reasonably excluded. Our data also reinforce existing literature showing that microvascular lesions do not have absolute specificity for a diagnosis of antibody-mediated rejection.

Authors+Show Affiliations

1 Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China. 2 Department of Organ Transplantation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 3 Department of Pathology, The Thomas E Starzl Transplantation Institute, University of Pittsburgh, School Of Medicine, Pittsburgh, PA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26901079

Citation

Zhao, Xiaomu, et al. "Rejection of the Renal Allograft in the Absence of Demonstrable Antibody and Complement." Transplantation, vol. 101, no. 2, 2017, pp. 395-401.
Zhao X, Huang G, Randhawa S, et al. Rejection of the Renal Allograft in the Absence of Demonstrable Antibody and Complement. Transplantation. 2017;101(2):395-401.
Zhao, X., Huang, G., Randhawa, S., Zeng, G., Lunz, J., & Randhawa, P. (2017). Rejection of the Renal Allograft in the Absence of Demonstrable Antibody and Complement. Transplantation, 101(2), 395-401. https://doi.org/10.1097/TP.0000000000001118
Zhao X, et al. Rejection of the Renal Allograft in the Absence of Demonstrable Antibody and Complement. Transplantation. 2017;101(2):395-401. PubMed PMID: 26901079.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rejection of the Renal Allograft in the Absence of Demonstrable Antibody and Complement. AU - Zhao,Xiaomu, AU - Huang,Gang, AU - Randhawa,Simrath, AU - Zeng,Gang, AU - Lunz,John, AU - Randhawa,Parmjeet, PY - 2016/2/24/pubmed PY - 2017/5/30/medline PY - 2016/2/23/entrez SP - 395 EP - 401 JF - Transplantation JO - Transplantation VL - 101 IS - 2 N2 - BACKGROUND: Recent literature has stressed the prominent role of antibodies in graft loss. This study was designed to assess a growing perception that T cell-mediated rejection (TCMR) is no longer clinically relevant. METHODS: Five hundred forty-five renal allograft recipients over a 3-year period were screened for biopsies with: (a) TCMR including borderline change (BL), (b) negative complement protein C4 degradation fragment, and (c) absence of donor-specific antibody at time of transplant, within 30 days of the biopsy, and up to 4 measurements at later time points. RESULTS: These stringent requirements identified 28 "pure" cases of late TCMR/BL. Low-grade glomerulitis, peritubular capillaritis, or chronic transplant glomerulopathy were found in 9/28 (32%) biopsies. Serum creatinine showed complete short-term remission in 7/10 (70%) BL and 9/18 (50%) TCMR patients 1 month postbiopsy. Yet, both treated and untreated patients demonstrated further decline in graft function as assessed by serum creatinine and estimated glomerular filtration rate. CONCLUSIONS: Late TCMR seen in 7.9% of biopsies can contribute to significant deterioration of graft function in patients in whom the dominant contribution of antibody-mediated injury has been reasonably excluded. Our data also reinforce existing literature showing that microvascular lesions do not have absolute specificity for a diagnosis of antibody-mediated rejection. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/26901079/Rejection_of_the_Renal_Allograft_in_the_Absence_of_Demonstrable_Antibody_and_Complement_ L2 - http://dx.doi.org/10.1097/TP.0000000000001118 DB - PRIME DP - Unbound Medicine ER -