Isolated v‐lesion in kidney transplant recipients: Characteristics,association with DSA,and histological follow‐up |
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| Authors: | Marion Rabant Fanny Boullenger Viviane Gnemmi Gaëlle Pellé François Glowacki Alexandre Hertig Isabelle Brocheriou Caroline Suberbielle Jean‐Luc Taupin Dany Anglicheau Christophe Legendre Jean‐Paul Duong Van Huyen David Buob |
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| Affiliation: | 1. Pathology Department, Necker Hospital, Assistance Publique‐H?pitaux de Paris, Paris,, France;2. Paris Descartes, Sorbonne Paris Cité University, Paris, France;3. Nephrology department, Centre hospitalier intercommunal André Grégoire, Montreuil, France;4. Pathology department, CHRU Lille, Lille 2 University, Lille, France;5. Kidney transplant department, Foch Hospital, Suresnes, France;6. Kidney transplant department, CHRU Lille, Lille 2 University, Lille, France;7. Kidney transplant department, Tenon Hospital, Assistance Publique‐H?pitaux de Paris, Paris, France;8. Pathology department, Tenon Hospital, Assistance Publique‐H?pitaux de Paris, Paris, France;9. Sorbonne Universités, UPMC Paris 06, Paris, France;10. Inserm, UMR S 1155, Paris, France;11. Histocompatibility department, Saint‐Louis Hospital, Assistance Publique‐H?pitaux de Paris, Paris, France;12. Department of Nephrology and Kidney transplantation, Necker Hospital, Assistance Publique‐H?pitaux de Paris, Paris, France;13. Paris Translational Research Center for Organ Transplantation, INSERM, UMR‐S970, Paris, France |
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| Abstract: | Isolated v‐lesion (IvL) represents a rare and challenging situation in renal allograft biopsies because it is unknown whether IvL truly represents rejection, antibody‐ or T cell–mediated, or not. This multicentric retrospective study describes the clinicopathological features of IvL with an emphasis on the donor‐specific antibody (DSA) status, histological follow‐up, and graft survival. Inclusion criteria were the presence of v‐lesion with minimal interstitial (i ≤ 1) and microvascular inflammation (g + ptc≤1). C4d‐positive biopsies were excluded. We retrospectively found 33 IvL biopsies in 33 patients, mainly performed in the early posttransplantation period (median time 27 days) and clinically indicated in 66.7%. A minority of recipients (5/33, 15.2%) had DSA at the time of biopsy. IvL was treated by anti‐rejection therapy in 21 cases (63.6%), whereas 12 (36.4%) were untreated. Seventy percent of untreated patients and 66% of treated patients showed favorable histological evolution on subsequent biopsy. Kidney graft survival in IvL was significantly higher than in a matched cohort of antibody‐mediated rejection with arteritis. In conclusion, IvL is not primarily antibody‐mediated and may show a favorable evolution. The heterogeneity of IvL pathophysiology on early biopsies should prompt DSA testing as well as close clinical and histological follow‐up in all patients with IvL. |
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| Keywords: | biopsy classification systems: Banff classification clinical research/practice kidney transplantation/nephrology pathology/histopathology rejection rejection: antibody‐mediated (ABMR) |
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