A New Diagnostic Algorithm for Antibody‐Mediated Microcirculation Inflammation in Kidney Transplants
We studied the significance of microcirculation inflammation in kidney transplants, including 329 indication biopsies from 251 renal allograft recipients, who were mostly nonpresensitized (crossmatch negative). Glomerulitis (g) and peritubular capillaritis (ptc) were often associated with antibody‐m...
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| container_title | American journal of transplantation |
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| creator | Sis, B. Jhangri, G. S. Riopel, J. Chang, J. de Freitas, D. G. Hidalgo, L. Mengel, M. Matas, A. Halloran, P. F. |
| description | We studied the significance of microcirculation inflammation in kidney transplants, including 329 indication biopsies from 251 renal allograft recipients, who were mostly nonpresensitized (crossmatch negative). Glomerulitis (g) and peritubular capillaritis (ptc) were often associated with antibody‐mediated rejection (65% and 75%, respectively), but were also found in other diseases in the absence of donor‐specific antibody (DSA): T‐cell‐mediated rejection (ptc, g), glomerulonephritis (g) and acute tubular necrosis (ptc). To develop rules for reducing the nonspecificity of microcirculation inflammation and defining the best grading thresholds associated with DSA, we built and validated a decision tree to predict DSA. The decision tree revealed that g + ptc sum (addition of g‐score plus ptc‐score) was the best predictor of DSA, followed by time posttransplant, then C4d, which had a small role. Late biopsies with g + ptc > 0 showed higher frequency of DSA compared to early biopsies with g + ptc > 0 (79% vs. 27%). Microcirculation inflammation in early biopsies was often false positive (antibody‐independent). The decision tree predicted DSA with higher sensitivity and accuracy than C4d staining. Microcirculation inflammation sum score predicted graft failure independently of time, C4d and transplant glomerulopathy. Thus any degree of microcirculation inflammation in late kidney transplant biopsies strongly indicates presence of DSA and predicts progression to graft failure.
This study proposes a new diagnostic algorithm to distinguish antibody‐mediated microcirculation inflammation from antibody‐independent etiologies in conventional nonhighly presensitized kidney transplants, and defines a grading threshold for microcirculation inflammation with a high specificity for antibody‐mediated rejection. |
| doi_str_mv | 10.1111/j.1600-6143.2011.03931.x |
| format | Article |
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This study proposes a new diagnostic algorithm to distinguish antibody‐mediated microcirculation inflammation from antibody‐independent etiologies in conventional nonhighly presensitized kidney transplants, and defines a grading threshold for microcirculation inflammation with a high specificity for antibody‐mediated rejection.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/j.1600-6143.2011.03931.x</identifier><identifier>PMID: 22300601</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Antigens, CD - metabolism ; Banff ; Biological and medical sciences ; Child ; Child, Preschool ; Decision Trees ; diagnosis ; Female ; Follow-Up Studies ; Glomerulonephritis - immunology ; Glomerulonephritis - pathology ; Graft Rejection - blood ; Graft Rejection - diagnosis ; Graft Rejection - immunology ; Graft Survival - immunology ; Humans ; Immunoenzyme Techniques ; Inflammation - immunology ; Isoantibodies - blood ; Isoantibodies - immunology ; kidney ; Kidney Transplantation - immunology ; Male ; Medical sciences ; Microcirculation - immunology ; Middle Aged ; pathology ; Prognosis ; rejection ; Renal Circulation - immunology ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; survival ; Survival Rate ; transplantation ; Young Adult</subject><ispartof>American journal of transplantation, 2012-05, Vol.12 (5), p.1168-1179</ispartof><rights>Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2015 INIST-CNRS</rights><rights>Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5481-596b051110eae6175cffd9d13866373c1647c9a705d14f7abae1723a1d3cefbb3</citedby><cites>FETCH-LOGICAL-c5481-596b051110eae6175cffd9d13866373c1647c9a705d14f7abae1723a1d3cefbb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1600-6143.2011.03931.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1600-6143.2011.03931.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25963159$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22300601$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sis, B.</creatorcontrib><creatorcontrib>Jhangri, G. S.</creatorcontrib><creatorcontrib>Riopel, J.</creatorcontrib><creatorcontrib>Chang, J.</creatorcontrib><creatorcontrib>de Freitas, D. G.</creatorcontrib><creatorcontrib>Hidalgo, L.</creatorcontrib><creatorcontrib>Mengel, M.</creatorcontrib><creatorcontrib>Matas, A.</creatorcontrib><creatorcontrib>Halloran, P. F.</creatorcontrib><title>A New Diagnostic Algorithm for Antibody‐Mediated Microcirculation Inflammation in Kidney Transplants</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>We studied the significance of microcirculation inflammation in kidney transplants, including 329 indication biopsies from 251 renal allograft recipients, who were mostly nonpresensitized (crossmatch negative). Glomerulitis (g) and peritubular capillaritis (ptc) were often associated with antibody‐mediated rejection (65% and 75%, respectively), but were also found in other diseases in the absence of donor‐specific antibody (DSA): T‐cell‐mediated rejection (ptc, g), glomerulonephritis (g) and acute tubular necrosis (ptc). To develop rules for reducing the nonspecificity of microcirculation inflammation and defining the best grading thresholds associated with DSA, we built and validated a decision tree to predict DSA. The decision tree revealed that g + ptc sum (addition of g‐score plus ptc‐score) was the best predictor of DSA, followed by time posttransplant, then C4d, which had a small role. Late biopsies with g + ptc > 0 showed higher frequency of DSA compared to early biopsies with g + ptc > 0 (79% vs. 27%). Microcirculation inflammation in early biopsies was often false positive (antibody‐independent). The decision tree predicted DSA with higher sensitivity and accuracy than C4d staining. Microcirculation inflammation sum score predicted graft failure independently of time, C4d and transplant glomerulopathy. Thus any degree of microcirculation inflammation in late kidney transplant biopsies strongly indicates presence of DSA and predicts progression to graft failure.
This study proposes a new diagnostic algorithm to distinguish antibody‐mediated microcirculation inflammation from antibody‐independent etiologies in conventional nonhighly presensitized kidney transplants, and defines a grading threshold for microcirculation inflammation with a high specificity for antibody‐mediated rejection.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Algorithms</subject><subject>Antigens, CD - metabolism</subject><subject>Banff</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Decision Trees</subject><subject>diagnosis</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glomerulonephritis - immunology</subject><subject>Glomerulonephritis - pathology</subject><subject>Graft Rejection - blood</subject><subject>Graft Rejection - diagnosis</subject><subject>Graft Rejection - immunology</subject><subject>Graft Survival - immunology</subject><subject>Humans</subject><subject>Immunoenzyme Techniques</subject><subject>Inflammation - immunology</subject><subject>Isoantibodies - blood</subject><subject>Isoantibodies - immunology</subject><subject>kidney</subject><subject>Kidney Transplantation - immunology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microcirculation - immunology</subject><subject>Middle Aged</subject><subject>pathology</subject><subject>Prognosis</subject><subject>rejection</subject><subject>Renal Circulation - immunology</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>survival</subject><subject>Survival Rate</subject><subject>transplantation</subject><subject>Young Adult</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkctOGzEUhi0EKre-AvIGiU0GHzv2TBZdjLgXaDdhbXl8oY7mEuyJIDsegWfkSfCQNF0Wb3wsf8c-__8jhIFkkNbpLANByEjAmGWUAGSETRhkL1tob3OxvakZ30X7Mc4IgZwW9BvapZQRIgjsIVfiX_YZn3v12Hax9xqX9WMXfP-nwa4LuGx7X3Vm-f76dm-NV701-N7r0Gkf9KJWve9afNO6WjXN6uBbfOtNa5d4GlQb57Vq-3iIdpyqo_2-3g_Qw-XF9Ox6dPf76uasvBtpPi5gxCeiIjwpJFZZATnXzpmJAVYIwXKmQYxzPVE54QbGLleVskkSU2CYtq6q2AE6Wb07D93TwsZeNj5qW6chbLeIEijPc8pZsuu_KAFCGaWFSGixQpPuGIN1ch58o8IyQXIIRM7k4LUcfJdDIPIzEPmSWo_WvyyqxppN498EEnC8BlTUqnbJM-3jPy5ZwoAP4_5Ycc--tssvDyDLn9OhYh9r9acS</recordid><startdate>201205</startdate><enddate>201205</enddate><creator>Sis, B.</creator><creator>Jhangri, G. S.</creator><creator>Riopel, J.</creator><creator>Chang, J.</creator><creator>de Freitas, D. G.</creator><creator>Hidalgo, L.</creator><creator>Mengel, M.</creator><creator>Matas, A.</creator><creator>Halloran, P. F.</creator><general>Blackwell Publishing Inc</general><general>Wiley</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QO</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope></search><sort><creationdate>201205</creationdate><title>A New Diagnostic Algorithm for Antibody‐Mediated Microcirculation Inflammation in Kidney Transplants</title><author>Sis, B. ; Jhangri, G. S. ; Riopel, J. ; Chang, J. ; de Freitas, D. G. ; Hidalgo, L. ; Mengel, M. ; Matas, A. ; Halloran, P. F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5481-596b051110eae6175cffd9d13866373c1647c9a705d14f7abae1723a1d3cefbb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Algorithms</topic><topic>Antigens, CD - metabolism</topic><topic>Banff</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Decision Trees</topic><topic>diagnosis</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glomerulonephritis - immunology</topic><topic>Glomerulonephritis - pathology</topic><topic>Graft Rejection - blood</topic><topic>Graft Rejection - diagnosis</topic><topic>Graft Rejection - immunology</topic><topic>Graft Survival - immunology</topic><topic>Humans</topic><topic>Immunoenzyme Techniques</topic><topic>Inflammation - immunology</topic><topic>Isoantibodies - blood</topic><topic>Isoantibodies - immunology</topic><topic>kidney</topic><topic>Kidney Transplantation - immunology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microcirculation - immunology</topic><topic>Middle Aged</topic><topic>pathology</topic><topic>Prognosis</topic><topic>rejection</topic><topic>Renal Circulation - immunology</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>survival</topic><topic>Survival Rate</topic><topic>transplantation</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sis, B.</creatorcontrib><creatorcontrib>Jhangri, G. S.</creatorcontrib><creatorcontrib>Riopel, J.</creatorcontrib><creatorcontrib>Chang, J.</creatorcontrib><creatorcontrib>de Freitas, D. G.</creatorcontrib><creatorcontrib>Hidalgo, L.</creatorcontrib><creatorcontrib>Mengel, M.</creatorcontrib><creatorcontrib>Matas, A.</creatorcontrib><creatorcontrib>Halloran, P. 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G.</au><au>Hidalgo, L.</au><au>Mengel, M.</au><au>Matas, A.</au><au>Halloran, P. F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A New Diagnostic Algorithm for Antibody‐Mediated Microcirculation Inflammation in Kidney Transplants</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2012-05</date><risdate>2012</risdate><volume>12</volume><issue>5</issue><spage>1168</spage><epage>1179</epage><pages>1168-1179</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>We studied the significance of microcirculation inflammation in kidney transplants, including 329 indication biopsies from 251 renal allograft recipients, who were mostly nonpresensitized (crossmatch negative). Glomerulitis (g) and peritubular capillaritis (ptc) were often associated with antibody‐mediated rejection (65% and 75%, respectively), but were also found in other diseases in the absence of donor‐specific antibody (DSA): T‐cell‐mediated rejection (ptc, g), glomerulonephritis (g) and acute tubular necrosis (ptc). To develop rules for reducing the nonspecificity of microcirculation inflammation and defining the best grading thresholds associated with DSA, we built and validated a decision tree to predict DSA. The decision tree revealed that g + ptc sum (addition of g‐score plus ptc‐score) was the best predictor of DSA, followed by time posttransplant, then C4d, which had a small role. Late biopsies with g + ptc > 0 showed higher frequency of DSA compared to early biopsies with g + ptc > 0 (79% vs. 27%). Microcirculation inflammation in early biopsies was often false positive (antibody‐independent). The decision tree predicted DSA with higher sensitivity and accuracy than C4d staining. Microcirculation inflammation sum score predicted graft failure independently of time, C4d and transplant glomerulopathy. Thus any degree of microcirculation inflammation in late kidney transplant biopsies strongly indicates presence of DSA and predicts progression to graft failure.
This study proposes a new diagnostic algorithm to distinguish antibody‐mediated microcirculation inflammation from antibody‐independent etiologies in conventional nonhighly presensitized kidney transplants, and defines a grading threshold for microcirculation inflammation with a high specificity for antibody‐mediated rejection.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>22300601</pmid><doi>10.1111/j.1600-6143.2011.03931.x</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Algorithms Antigens, CD - metabolism Banff Biological and medical sciences Child Child, Preschool Decision Trees diagnosis Female Follow-Up Studies Glomerulonephritis - immunology Glomerulonephritis - pathology Graft Rejection - blood Graft Rejection - diagnosis Graft Rejection - immunology Graft Survival - immunology Humans Immunoenzyme Techniques Inflammation - immunology Isoantibodies - blood Isoantibodies - immunology kidney Kidney Transplantation - immunology Male Medical sciences Microcirculation - immunology Middle Aged pathology Prognosis rejection Renal Circulation - immunology Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases survival Survival Rate transplantation Young Adult |
| title | A New Diagnostic Algorithm for Antibody‐Mediated Microcirculation Inflammation in Kidney Transplants |
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