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Morphologic Features and Clinical Impact of Arteritis Concurrent with Transplant Glomerulopathy

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Pathology & Oncology Research

Abstract

Little is known about the morphology and clinical relevance of arteritis in renal allograft biopsies with transplant glomerulopathy. We retrospectively reviewed the morphologic findings and clinical course of 59 patients with cg, 16 of which featured concurrent arteritis (fibrosing intimal arteritis with luminal narrowing in 15, and acute intimal arteritis in 1 case). Fifteen out of the 16 cases with arteritis fulfilled the morphological diagnostic criteria for chronic active antibody-mediated rejection, and 11 cases with arteritis showed morphological evidence of concurrent, ongoing T-cell-mediated alloimmune response (acute T-cell-mediated rejection in 5, borderline changes in 6 cases). Further, the Banff grades of interstitial inflammation in scarred and nonscarred cortex, total cortical inflammation, and arterial luminal narrowing were significantly higher in biopsies with arteritis. By immunohistochemistry, T-lymphocyte predominance over macrophages was found in the intimal infiltrates in 14 out of 16 cases, and cytotoxic T-lymphocytes were identified among intimal mononuclears in 10 cases. Patients with arteritis demonstrated a significantly shorter renal survival (7.5 vs. 29 months). In conclusion, T-cell-mediated mechanisms could play a role in the development of arteritis concurrent with cg. However, this finding does not exclude the possibility that antibody-mediated rejection can also contribute to the evolution of the lesion. Importantly, the lesion carries negative prognostic value likely via severe arterial luminal narrowing.

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Acknowledgments

Supported by TÁMOP grant 4.2.2.A-11/1/KONV-2012-0035 to B.I.

The authors are grateful to Katalin Virág, a PhD student at the Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary, for her valuable comments.

Disclosure

The authors declare that they have no conflict of interest. Elements of this study were presented at the 25th European Congress of Pathology held in Lisbon, Portugal, from August 31 to September 4, 2013.

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Authors and Affiliations

  1. Department of Pathology, University of Szeged, Allomas u. 2., H-6720, Szeged, Hungary

    Deján Dobi, Zsolt Bodó, Éva Kemény & Béla Iványi

  2. Department of Medical Physics and Informatics, University of Szeged, Koranyi fasor 9., H-6720, Szeged, Hungary

    Krisztina Boda

  3. Department of Surgery, University of Szeged, Szokefalvi-Nagy u. 6., H-6720, Szeged, Hungary

    Pál Szenohradszky & Edit Szederkényi

  4. Department of Pathology, University of California, San Francisco, 513 Parnassus Avenue, Room S566, San Francisco, CA, 94143-0102, USA

    Zoltan G. Laszik

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  1. Deján Dobi
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  2. Zsolt Bodó
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  3. Éva Kemény
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  8. Béla Iványi
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Correspondence to Deján Dobi.

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Dobi, D., Bodó, Z., Kemény, É. et al. Morphologic Features and Clinical Impact of Arteritis Concurrent with Transplant Glomerulopathy. Pathol. Oncol. Res. 22, 15–25 (2016). https://doi.org/10.1007/s12253-015-9962-3

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  • DOI: https://doi.org/10.1007/s12253-015-9962-3

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