Introduction: The Microcirculation Inflammation (IM) in kidney transplants is a strong predictor of graft loss inde-pedent of C4d and donor specific antibody(DSA)

Objetive

Analysis of kidney allograft biopsies (Bx) with IM, and its correlation with C4d deposits, presence of DSA, allograft function, histological feature in late biopsies and allograft outcome.

Material and Methods: Biopsies with IM between 2008-2015 were included. STATA 8 was used Statistical analysis. (College Station, TX USA) Continuous variables were reported as mean ± standard deviation (ds). Kruskal-Wallis test were used for difference between groups. P > 0.05 was considered statistical significant.

Results: 74 of 821 biopsies with IM were analyzed. Age of the patient 41.69 ±14.19 years, 37 men, 68 kidney transplants isolated, 46 cadaveric donor. All Bx were done for dysfunction or proteinuria(Pr). Creatinine at time Bx was 3.1 ± 1.76 mg / dL and Pr 0.97 ± 1.1 g.IM was associated with rejection in 87.83% of cases (p 0.0001). Early Acute Rejection in 32 Bx (49%) (p0.0001) and Late Acute Rejection in 33 Bx (51%) (p0.0001).Isolated Cellular Rejection (ACR) 35 (53.84%), and Mixed 29 (44.61%). Both glomerulits and capillaritis were found in 52 (70.27%)Bx. Deposit of C4d was positive in 63/74 Bx (85%) (p0.0001), C4d gomerular in 58 (70.27%) (p0.0001), capilar peritubular(PTC) 28 (38.35%) (p .0001). DSA positive was 28 (37.8%) (p0.0001).In 57 patiens follow up biopsies was performed and ACR was detected in 82.4%, acute humoral rejection 26%, chronic humoral rejection 54%, C4d was positive in PTC 26.78% and glmerulo 78.9%. Persistence of IM was seen in 70% rebiopsies and was correlated with chronic humoral rejection (p0.0001)and chronic vascular rejection (p 0.0001). Creatinine and proteinuria/24 hs at 3 and 5 years was 1.86mg/dl ± 0.94, 0.36gr ± 0.315 and 2.1 ± 0.84, 0.7 ± 0.33 respectively. Graft failure occurred in 15 patients: 9 of immunological cause, 2 of non-immunological cause, 4 death with functional graft.

Conclusion: The inflamation of the microcirculation in allograft biopsies correlated significantly with deposit C4d presence DSA, acute early and late rejection and humoral-cellular chronic rejection.

CITATION INFORMATION: Giordani M, Bedini Rocca M, Groppa S, Mombelli C, Christiansen S, Ocampo M, Rosa Diez G, Imperiali N. Microcirculation Inflammation in Kidney Allograft Biopsies. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress