Ptc extent + score in low-grade inflammation predicts graft loss.

Nicolas Kozakowski, Harald Herkner, Farsad Eskandary, Michael Eder, Wolfgang Winnicki, Johannes Kläger, Gregor Bond, Željko Kikic

Overview

Taking into account the extent of peritubular capillaritis enhance the predictive value of the ptc score.

Summary

The current scoring system could be adapted accordingly.

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Author Comments

Nicolas Kozakowski, MD
Nicolas Kozakowski, MD
Medical University of Vienna
Dr.
Renal & transplant pathology
Vienna, 1090 | Austria
This should be the basis for a multicentre validation study.Nicolas Kozakowski, MD

Resources

European Congress of Pathology 2019 - Nice - Renal transplant pathology: the French perspective
https://esp-nephropathology-working-group.org/meeting-lectures/

An integrative approach for the assessment of peritubular capillaritis extent and score in low-grade microvascular inflammation-associations with transplant glomerulopathy and graft loss.

Authors:
Nicolas Kozakowski, MD
Nicolas Kozakowski, MD
Medical University of Vienna
Dr.
Renal & transplant pathology
Vienna, 1090 | Austria

Nephrol Dial Transplant 2019 01;34(1):166-174

Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.

Background: Peritubular capillaritis (ptc), reported by the ptc score, is a major feature of kidney allograft rejection and microvascular inflammation (MVI). MVI sum scores (ptc + glomerulitis score ≥2) are accepted diagnostic surrogates of human leucocyte antigen (HLA)-antibody interaction. However, low-grade inflammation is common and ptc scores (number of leucocytes/capillary) may not mirror all aspects of ptc morphology. Recently we observed a relationship of the diffuse extent of ptc (inflammation of >50% of the renal cortex) with graft loss and significantly higher donor-specific antibody levels, suggesting potential inclusion of diffuse ptc as an additional surrogate of antibody-antigen interaction.

Methods: We sought to assess how a combination of ptc score and extent in low-grade inflammation (ptc1) affects transplant glomerulopathy (TG) and graft loss risk. Patients (n = 616) were assessed for MVI in first indication biopsies. Cases with a ptc score of 1 but diffuse extent (ptc1diffuse, g-score = 0, n = 26) were considered additional surrogates of HLA-antibody interaction and compared with MVI ≥2 and MVI <2.

Results: The ptc1diffuse and MVI score ≥2 subjects had worse graft survival (42% and 59%) compared with an MVI score <2 (70%) (P = 0.002). The incorporation of ptc1diffuse in the MVI score ≥2 increased the receiver operating characteristics curve for TG [area under the curve (AUC) 0.602; P = 0.008] compared with a Banff MVI score ≥2 (AUC 0.56; P = 0.12); cases with baseline TG were excluded. In multivariate analysis, ptc1diffuse remained independently related to TG (odds ratio 3.89; P = 0.008) and graft loss (hazard ratio 2.64; P = 0.001) even after inclusion of all rejection episodes.

Conclusion: An integrated view of ptc morphology including diffuse ptc in MVI is superior for TG and graft loss risk assessment.

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Source
http://dx.doi.org/10.1093/ndt/gfy192DOI Listing
January 2019
3.577 Impact Factor

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References

(Supplied by CrossRef)
Evidence for antibody-mediated injury as a major determinant of late kidney allograft failure
Gaston et al.
Transplantation 2010
The impact of donor-specific anti-HLA antibodies on late kidney allograft failure
Loupy et al.
Nat Rev Nephrol 2012
Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence
Sellares et al.
Am J Transplant 2012
Complement-binding anti-HLA antibodies and kidney-allograft survival
Loupy et al.
N Engl J Med 2013
Diagnosis and management of antibody-mediated rejection: current status and novel approaches
Djamali et al.
Am J Transplant 2014
A new diagnostic algorithm for antibody-mediated microcirculation inflammation in kidney transplants
Sis et al.
Am J Transplant 2012
Banff 2013 meeting report: inclusion of C4d-negative antibody-mediated rejection and antibody-associated arterial lesions
Haas et al.
Am J Transplant 2014
The Banff 2015 Kidney Meeting Report: current challenges in rejection classification and prospects for adopting molecular pathology
Loupy et al.
Am J Transplant 2017
Transplant glomerulopathy, late antibody-mediated rejection and the ABCD tetrad in kidney allograft biopsies for cause
Sis et al.
Am J Transplant 2007
Diffuse extent of peritubular capillaritis in late antibody-mediated rejection: associations with levels of donor-specific antibodies and chronic allograft injury
Kozakowski et al.
Transplantation 2017
Capillary C4d and kidney allograft outcome in relation to morphologic lesions suggestive of antibody-mediated rejection
Kikic et al.
Clin J Am Soc Nephrol 2015

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