The prevalence of serologic and histologic features of AMR in early and late biopsies and in association with graft fuction has not been well-recognized. We examined these features in 1101 biopsy specimens in 861 patients, biposied Dec. 2009-Apr. 2012.
Table 1 summarizes these features.
|<12 mo||>12 mo|
|Glom CD68 >12||7.7%||14.4%||14.9%||31.4%|
|TG by EM||2.3%||5.3%||7.1%||30.0%|
|Glom endothelial injury||7.4%||11.5%||7.1%||7.1%|
Acute cellular rejection was not associated with time of biopsy, but more likely in inidication biopsies (aOR:3.5, p<0.001,CI:1.9-6.6). C4d positivity was not related to time but type of biopsy (aOR:3.0, p<0.001,CI:2.2-4.1). While, DSA was associated with both (aOR:1.8, p<0.001,CI:1.4-2.3 for>12mo; aOR:1.7, p=0.001,CI:1.2-2.2 for indication). Transplant glomerulopathy (TG) was more likely in late and indication biopsies (aOR:8.3, p<0.001,CI:4.7-14.7; aOR:3.4, p<0.001,CI:1.9-6.1, respectively). So was Glomerulitis &/or capillaritis (MV inflammation) (aOR: 2.7, p<0.001,CI:2.0-3.7 and aOR:2.9, p<0.001,CI:2.1-4.2, respectively). Glomerular endothelial cell injury by EM was not associated with the time or type of biopsy. Likelihood of higher g score increased with late biopsies (aRRR:2.7, p<0.001 for g1; 3.6, p<0.001 for g2; 11.4, p=0.001 for g3). Glomerular CD68+ cells>12 was also associated with the two (aOR:2.3, p<0.001,CI:1.6-3.4 for late, and aOR:2.5, p<0.001,CI:1.8-3.5 for indication biopsies). Class I DSA alone was only associated with type of biopsy (aOR:1.9, p,0.04,CI:1.0-3.4), class II DSA only with time (aOR:1.9, p<0.001,CI:1.4-2.7), and class I & II DSA with both (aOR:3.1, p<0.001,CI:1.7-5.5 for indication, and aOR:2.0, p=0.002,CI:13-3.2 for late biopsies, respectively).
Our observation in this large cohort shows that ACR, endothelial injury, and C4d are not time-related. In contrast, class II DSA +/- class I, MV inflammation, higher g score, CD68+ cells>12, and TG are associated with time and often type of biopsy. This suggest that in later stages post-transplat, class II DSA-induced graft injury is more mediated by cellular elements rather than complement activation.
To cite this abstract in AMA style:Haririan A, Papadimitriou J, Klassen D, Ugarte R, Bromberg J, Kukuruga D, Drachenberg C. Features of Antibody-Mediated Rejection (AMR) in Early and Late Protocol and Indication Renal Allograft Biopsies [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/features-of-antibody-mediated-rejection-amr-in-early-and-late-protocol-and-indication-renal-allograft-biopsies/. Accessed May 7, 2021.
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