Background: Transplant glomerulopathy (TG) is a prognostic marker for graft survival. Still, scoring TG using the Banff cg-score remains a challenge and no assessments in a continuous system have been done. In this study, we evaluated the assessment of TG by Banff criteria and compared with three morphometric TG measurements.

Methods: The discovery set included 74 cases exhibiting antibody-mediated injury re-scored for cg by 4 pathologists using Banff criteria. TG by morphometry was assessed on silver stained slides on all glomeruli by three different ways: 1) Simple TG score: percent of glomeruli with presence of double contour regardless of the percentage of area involved 2) Quadrant TG score: percent of all quadrants with presence of double contour 3) Worst glom TG score: percent of glomeruli with TG present in all four quadrants. Each morphometric score was compared to the average Banff cg-score of the 74 cases. Subsequent validation and correlation with long-term allograft outcomes were done in 222 5-year protocol biopsies from adult solitary kidney recipients transplanted between 2002-2013, who were blood group compatible and had a negative cross-match.

Results: The average cg-score of the 4 pathologists and TG by morphometry showed significant correlation (Table 1). In the 5 year cohort, the correlation remained significant for all morphometric scores (Table 1). Five year Banff and morphometric scores were associated with a higher risk of graft loss by 10 years (cg-score HR=2.00; quadrant TG score per 10% HR=1.26 and worst glom TG score per 10% HR=1.33, all p<0.0001). The 5 year simple TG score was not associated with graft loss by 10 years. Among patients with cg-score of 0, the 5 year worst TG score was higher in patients with graft loss than in those without graft loss (4.90% vs 0.82%, p=0.005) and predicted a graft loss by 10 years (per 10% HR=1.51, p<0.002).

Conclusion: Continuous scores for TG by morphometry were tested and validated. Five year Banff cg-score, quadrant TG and worst glom TG scores are associated with poor 10 year graft survival and the worst glom TG score may be more sensitive than Banff cg-score.

CITATION INFORMATION: Morales M., Denic A., Park W., Smith B., Alexander M., Stegall M. Scoring Transplant Glomerulopathy Using Morphometry: Correlation with Banff Criteria Am J Transplant. 2017;17 (suppl 3).

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