Bowman capsulitis predicts poor kidney allograft outcome in T cell-mediated rejection.

Authors:
Alexander J Gallan
Alexander J Gallan
USA. Electronic address: Alexander.Gallan@uchospitals.edu
Woojin James Chon
Woojin James Chon
The University of Missouri-Kansas City
Michelle A Josephson
Michelle A Josephson
University of Chicago
Chicago | United States
Patrick N Cunningham
Patrick N Cunningham
University of Chicago
Kammi J Henriksen
Kammi J Henriksen
University of Chicago Medical Center
United States
Anthony Chang
Anthony Chang
University of Chicago
United States

Hum Pathol 2018 06 6;76:47-51. Epub 2018 Mar 6.

Department of Pathology, The University of Chicago, Chicago, IL 60637, USA.

Acute T cell-mediated rejection (TCMR) is an important cause of renal allograft loss. The Banff classification for tubulointerstitial (type I) rejection is based on the extent of both interstitial inflammation and tubulitis. Lymphocytes may also be present between parietal epithelial cells and Bowman capsules in this setting, which we have termed "capsulitis." We conducted this study to determine the clinical significance of capsulitis. We identified 42 patients from the pathology archives at The University of Chicago with isolated Banff type I TCMR from 2010 to 2015. Patient demographic data, Banff classification, and graft outcome measurements were compared between capsulitis and noncapsulitis groups using Mann-Whitney U test. Capsulitis was present in 26 (62%) and was more frequently seen in Banff IB than in IA TCMR (88% versus 44%, P = .01). Patients with capsulitis had a higher serum creatinine at biopsy (4.6 versus 2.9 mg/dL, P = .04) and were more likely to progress to dialysis (42% versus 13%, P = .06), with fewer recovering their baseline serum creatinine (12% versus 38%, P = .08). Patients with both Banff IA TCMR and capsulitis have clinical outcomes similar to or possibly worse than Banff IB TCMR compared with those with Banff IA and an absence of capsulitis. Capsulitis is an important pathologic parameter in the evaluation of kidney transplant biopsies with potential diagnostic, prognostic, and therapeutic implications in the setting of TCMR.

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http://dx.doi.org/10.1016/j.humpath.2018.02.016DOI Listing

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June 2018
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