Clinical Significance of Isolated v1 Arteritis in Renal Transplantation.
1Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
2Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
3Undergraduate Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Meeting: 2016 American Transplant Congress
Abstract number: 27
Keywords: Biopsy, Graft survival, Kidney transplantation, Rejection
Session Information
Date: Sunday, June 12, 2016
Session Name: Concurrent Session: Kidney Acute Cellular Rejection: Clinical Outcomes and Pathological Characteristics
Session Time: 2:30pm-4:00pm
Presentation Time: 2:30pm-2:42pm
Location: Ballroom C
INTRO: The presence of intimal arteritis (v) in renal transplant biopsies (Bx) establishes Grade II-III AVR (Acute Vascular Rejection) according to the Banff Classification. The clinical significance of “isolated v” lesions (v1) in this group, characterized by arteritis alone vs lesions of arteritis with tubulointerstitial inflammation (i-t-v) is unknown.
METHODS: In patients undergoing kidney transplantation between 2005-2013, 'for cause' Bx were retrospectively reviewed at our center utilizing Banff Classification. Those with Grade IIa AVR were separated into groups with isolated v1 arteritis and i-t-v. Clinical outcomes including renal function prior to and after treatment, patient graft and overall survival and post-treatment Bx results were assessed. Statistical analysis was performed.
RESULTS: In our review, 613 Bx in 280 patients were performed. Of these, 110 Bx showed Grade IIa rejection in 83 patients. Fifty-one (61%) were isolated v1, while 29 (35%) were i-t-v. There were no significant differences in recipient or donor age (46 vs 40; 42 vs 40, p=NS), PRA pre-transplant, or donor status (LD, DCD or NDD) between groups. Mean time from transplant to Bx proven arteritis was 8mo vs 13mo, p=NS. Patients in the v1 group were more likely to have associated C4d+ (32% vs. 17%). All patients with v1 received pulsed steroids (methylprednisolone 250 mg daily x 3) only, whereas 76% i-t-v patients received thymoglobulin or IVIG in adjunct to steroids. Half of total events (death or graft failure) occurred in the first year post transplant in the i-t-v group (none in v1 group). Mean time from Bx to death or graft failure was 8mo vs. 22mo (p=NS). At a median follow-up time of 41 months from transplant, death censored graft survival was 92% (v1) compared to 79% (i-t-v) (p=0.04) and overall survival was 98% vs 79% (p<0.004).
CONCLUSION: Despite having the same Banff Classification of IIa AVR, graft survival in patients with isolated v1 rejection is markedly superior compared to those with tubulointerstitial inflammation. Modification of the Banff Criteria Grading scheme should be considered if these findings are corroborated in a larger multi-center study.
CITATION INFORMATION: Mikhail D, Wei J, Kleinsteuber D, Gabril M, Sener A, Moussa M, Luke P. Clinical Significance of Isolated v1 Arteritis in Renal Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Mikhail D, Wei J, Kleinsteuber D, Gabril M, Sener A, Moussa M, Luke P. Clinical Significance of Isolated v1 Arteritis in Renal Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-significance-of-isolated-v1-arteritis-in-renal-transplantation/. Accessed July 23, 2018.« Back to 2016 American Transplant Congress