NDLI: Acute transplant glomerulopathy is associated with antibody-mediated rejection and poor graft outcome.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Nair, R. Fraer, M. Agrawal, N. Suneja, M.
Spatial Coverage	Iowa
Description	Country affiliation: United States Author Affiliation: Nair R ( Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins, Dr., 5243 RCP, Iowa City, IA 52242, USA. ramesh-nair@uiowa.edu)
Abstract	Transplant glomerulopathy (TG) is traditionally considered to be a chronic entity. However, in our practice we observed patients who presented with features of TG as early as 14 days posttransplantation. We investigated the clinicopathological features of these cases. During a 4-year period, all patients with acute rejection were identified. Charts were reviewed to identify patients with antibody-mediated rejection and biopsy features of TG within 6 months posttransplantation. Three patients met the above-mentioned criteria. All of them had diffuse margination of inflammatory cells in peritubular capillaries in the setting of acute renal failure or delayed graft function. Monocyte (CD68-positive) margination in peritubular capillaries was a common feature. All 3 patients had donor-specific antibodies and features suggestive of antibody-mediated rejection. C4d stain in peritubular capillaries was focal and mild or absent in serial biopsies. Occlusive endothelial swelling of glomerular capillary loops (endotheliosis) preceded TG. None of the patients had evidence for other causes of similar glomerular changes in a transplant, such as calcineurin inhibitor toxicity, ischemia, hepatitis C, or immune complex glomerulonephritis. They did not have other biopsy features of chronicity when TG appeared and as it progressed. TG can occur as an acute phenomenon. We propose that endotheliosis is a more accurate and specific precursor of TG than mere glomerulitis. These cases of acute TG may represent a form of antibody-mediated rejection associated with proteinuria and poor response to treatment.
File Format	HTM / HTML
ISSN	00411345
Issue Number	9
Volume Number	42
e-ISSN	18732623
Journal	Transplantation Proceedings
Language	English
Publisher	Elsevier
Publisher Date	2010-11-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Transplantation__semicolon__medicine Graft Rejection Immunology Immunity, Humoral Kidney Diseases Kidney Transplantation Adverse Effects Kidney Acute Disease Acute Kidney Injury Aged Antigens, Cd Antigens, Differentiation, Myelomonocytic Biopsy Capillaries Complement C4b Analysis Delayed Graft Function Pathology Therapy Humans Immunosuppressive Agents Therapeutic Use Iowa Blood Supply Macrophages Male Middle Aged Peptide Fragments Proteinuria Time Factors Treatment Outcome Journal Article
Content Type	Text
Resource Type	Article
Subject	Transplantation Surgery

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