Introduction

Chronic active antibody mediated rejection (c-aABMR) in the renal allograft may occur with isolated arteritis. Isolated v-lesions have been associated with an inferior graft outcome. We analysed the impact of isolated arteritis with regards to outcome in patients with c-aABMR (c-aABMR+v).

Patients and methods

In a retrospective cohort of patients diagnosed with c-aABMR we identified 17 patients with c-aABMR+v. Patients were scored according to Banff '15 classification and DSA status was determined at time of biopsy by single bead Luminex assay. All cases of c-aABMR were given anti-rejection treatment. Most patients with c-aABMR+v (88%) received treatment with intravenous methylprednisolone (MP) and intravenous immunoglobulins (IVIG), in some cases followed by a T cell depleting agent (29%). Patients with c-aABMR+v were compared to patients with c-aABMR without v- lesions. Decline in renal allograft function prior to therapy and response to therapy were analysed for both groups. Responders to therapy were defined as having an eGFR at 1 year after treatment that was superior than the eGFR projected from the decline in eGFR the year before treatment.

Results

The Banff classification of patients with c-aABMR+v did not significantly differ from those without v-lesions. Of note, 76% (n=13) of c-aABMR+v had no tubulitis and 47% had C4d positive staining of the peritubular capillaries (p>0.1 compared to those without v) .

On average, patients with c-aABMR+v showed a faster decline in graft function in the year before treatment (-16.2 ml/min/1.73m²) compared to those without v (9.8 ml/min/1.73m², p<0.01). Patients with c-aABMR+v responded to therapy leading to an average decline in eGFR of 4.8 ml/min/1.73m² in the year after treatment. Seventy-one percent of the c-aABMR+v patients were considered responders. Paradoxical, allograft survival at 3 year was only 54% due to a low eGFR at start of treatment in patients who subsequently lost their graft. Despite a significant decrease in eGFR loss, treatment was not sufficient to halt further progression to ESRD.

Conclusions

Patients with c-aABMR and isolated v-lesions in their renal biopsy have a faster decline in renal function prior to therapy but show a superior response to treatment. Early recognition and treatment of these patients may prevent graft loss.

CITATION INFORMATION: Sablik K., Clahsen-van Groningen M., Looman C., Betjes M. Patients with C-aABMR and V-Lesions in Their Renal Transplant Biopsy Have a Superior Response to Treatment Am J Transplant. 2017;17 (suppl 3).

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