Introduction: The importance of the endarteritis on graft survival in recipients with AMR is controversial. Thus we aimed to understand the prognostic value of the presence of endarteritis in recipients with AMR.

Methods: Of 155 recipients 72 (46.5%) had pure AMR (Group 1) while 83 (53.5%) had both AMR and endarteritis (Group 2). Endarteritis was graded according to Banff. First indication biopsies of all cases were reevaluated and the intensity of interstitial, glomerular and peritubular capillary (PTC) inflammation, neutrophil, macrophage and lymphocyte infiltration were graded. HLA-DR expression in the arteries, PTCs, and tubules were examined. Loss of DR expression on PTCs accepted as destruction of PTCs. Follow-up biopsies were analyzed for development of interstitial fibrosis (IF),transplant glomerulopathy (TG) and transplant arteriopathy (TA).

Results: Compared to Group 1 patients; the extent of the PTC and arterial C4d expression and the degree of PTC destruction was higher in Group 2(P<.001).The degree of the interstitial eosinophil, plasma, and macrophage infiltration was higher in Group 2 (p<.001). Also, the intensity of inflammatory cells and neutrophils in both glomeruli and PTCs were higher in Group 2 (p<.001). Group 2 patients showed a higher incidence of IF, TG and TA in follow-up biopsies (p<.01).The development of IF and TG increases with the increasing degree of glomerulitis, PTC-itis, C4d expression and PTC destruction (p<.01). Also, the time of the development of IF and TG decreased with increasing intensity of PTC and interstitial infiltration, glomerulitis, PTC destruction and C4d expression (p<.01). The presence of eosinophil and macrophage infiltration on artery walls of recipients with AMVR increases risk of TG and TA (p<.01). Patients who had arterial C4d staining had a higher risk of TG, TA and graft loss (p<.001). The response to rejection therapy was lower in Group 2 (p<.001). 3- and 5-year graft survival was 98%, and 85% for Group 1 and 57%, and 27% respectively for Group 2 (p<.001).

Conclusion: We show that the course of AMVR is noticeably different from pure AMR, with AMVR having a worse outcome by leading to early development of IF,TG, and TA. Development of new treatment strategies for AMVR could salvage many kidney allografts.

CITATION INFORMATION: Ozdemir B., Ozdemir F., Terzi A., Ozdemir G., Ok Atilgan A., Ayvazoglu Soy E., Akdur A., Moray G., Haberal M. Significance of Antibody-Mediated Vascular Rejection (AMVR) on Graft Survival: Correlation with Pure Antibody-Mediated Rejection (AMR) Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress