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Features of Antibody-Mediated Rejection (AMR) in Early and Late Protocol and Indication Renal Allograft Biopsies

A. Haririan, J. Papadimitriou, D. Klassen, R. Ugarte, J. Bromberg, D. Kukuruga, C. Drachenberg

Depts of Medicine,
Pathology,
Surgery, University of Maryland, Baltimore, MD

Meeting: 2013 American Transplant Congress

Abstract number: B979

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  • Microvascular Inflammation in Early Protocol Biopsies of Renal Allografts in Cases of Chronic Active Antibody-Mediated Rejection
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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.

Features of AMR by time and biopsy type
  <12 mo >12 mo
  Protocol Indication Protocol Indication
DSA 19.7% 26.7% 27.0% 41.1%
ACR 3.9% 10.2% 1.4% 9.0%
g score>0 7.3% 10.6% 12.1% 32.6%
cg score>0 1.9% 5.3% 6.4% 27.0%
MV inflammation 10.1% 18.4% 14.9% 42.2%
Glom CD68 >12 7.7% 14.4% 14.9% 31.4%
PTC C4d+ 17.4% 37.8% 16.3% 38.2%
TG by EM 2.3% 5.3% 7.1% 30.0%
Glom endothelial injury 7.4% 11.5% 7.1% 7.1%
cv score>0 59.6% 73.9% 66.4% 87.1%

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.

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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 January 18, 2021.

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