Isolated v-lesion represents a benign phenotype of vascular rejection of the kidney allograft - a retrospective study
Language English Country Switzerland Media print-electronic
Document type Journal Article
Grant support
15-26519A
Ministry of Health of the Czech Republic - International
PubMed
29855106
DOI
10.1111/tri.13286
Knihovny.cz E-resources
- Keywords
- antibody-mediated rejection, intimal arteritis, isolated v-lesion, kidney transplantation, vascular rejection,
- MeSH
- Biopsy MeSH
- Time Factors MeSH
- Adult MeSH
- Phenotype MeSH
- HLA Antigens immunology MeSH
- Immunosuppressive Agents MeSH
- Kaplan-Meier Estimate MeSH
- Kidney immunology pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Graft Survival MeSH
- Antibodies immunology MeSH
- Graft Rejection immunology MeSH
- Renal Insufficiency surgery MeSH
- Retrospective Studies MeSH
- Risk MeSH
- T-Lymphocytes immunology MeSH
- Kidney Transplantation adverse effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Names of Substances
- HLA Antigens MeSH
- Immunosuppressive Agents MeSH
- Antibodies MeSH
While the detrimental impact of the humoral acute vascular rejection (AVR) phenotype is recognized, the prognostic significance of isolated v-lesion (IV) remains unclear. In this retrospective single-centre study, AVR was found in 98 of 1015 patients (9.7%) who had undergone kidney transplantation in 2010-2014, with donor-specific antibodies (DSA) evaluated in all of them. The outcome of four AVR phenotypes was evaluated during median follow-up of 59 months; in 25 patients with IV, 18 with T-cell-mediated vascular rejection (TCMVR), 19 with antibody-mediated vascular rejection (AMVR) and 36 with suspected antibody-mediated rejection (sAMVR). AVR was diagnosed mainly by for-cause biopsy (81%) early after transplantation (median 19 POD) and appeared as mild-grade intimal arteritis. IV occurred in low-sensitized patients after the first transplantation (96%) in the absence of DSA. IV responded satisfactorily to treatment (88%), showed no persistence of rejection in surveillance biopsy, and had stable graft function, minimal proteinuria and excellent DCGS (96%). Contrary to that, Kaplan-Meier estimate of 3-year DCGS of AMVR was 66% (log-rank = 0.0004). Early IV represents a benign phenotype of AVR with a favourable outcome. This study prompts further research to evaluate the nature of IV before considering any change in the classification and management.
References provided by Crossref.org
Antibody-mediated rejection of renal allografts: diagnostic pitfalls and challenges
Early isolated V-lesion may not truly represent rejection of the kidney allograft
