Chronic antibody mediated rejection (ABMR) with Transplant glomerulopathy (TG) remains a major contributor of renal graft loss in the long term. New sensitive markers are needed to make an early diagnosis of disease in order to improve graft survival.

Using immunohistochemistry, an easily applicable technique in a routine lab, we studied the glomerular endothelial expression of fascin, glomerular basement membrane (GBM) deposition of fibronectin (FN) and type IV collagen (coll4), in 224 non selected biopsies from 170 renal transplanted patients including 61biopsies with ABMR and 163 without. We found FN and coll4 deposition in the GBM, combined with endothelial fascin expression in the glomeruli of transplant with ABMR. The GBM deposition of FN and coll4 was more pronounced in chronic ABMR than in acute ABMR. The level of expression of FN, coll4 and fascin was quantitated and was significantly correlated with banff g, ptc, cg, c4d scores, DSA and graft dysfunction in short and long term. Cox regression model of survival data analysis showed FN deposition in the GBM to be a strong and independent predictor for graft loss with an odds ratio (OR) of 3.6 (95% CI:1.35-9.7, p=0.011) after adjustment for g+ptc, c4d, DSA and other known risk factors for graft loss. Biopsies positive for these marker expression also predicted TG occurrence in late biopsies ( p<0.0001 by Fisher's exact test).

Conclusion: Glomerular fascin, fibronectin and collagen IV expressions are very early and sensitive biomarkers for glomerular injury during ABMR. They are also predictive of long term graft loss.

CITATION INFORMATION: Xu-Dubois Y-.C., Louis K., Jouanneau C., Buob D., Ouali N., Hertig A., Rondeau E. New Sensitive Markers for Early Diagnosis of Transplant Glomerulopathy in Kidney Recipients Am J Transplant. 2017;17 (suppl 3).

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