Clinical significance of isolated v lesions in paediatric renal transplant biopsies: muscular arteries required to refute the diagnosis of acute rejection
Summary Intimal vascular lesions are considered features of acute T‐cell‐mediated rejection yet can occur in the absence of tubulointerstitial inflammation, termed isolated ‘v’ lesions. The clinical significance of these lesions is unclear. The diagnosis requires a biopsy with the presence of arteri...
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| Veröffentlicht in: | Transplant international 2014-02, Vol.27 (2), p.170-175 |
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| creator | Brown, Chrysothemis C. Sebire, Neil J. Wittenhagen, Per Shaw, Olivia Marks, Stephen D. |
| description | Summary
Intimal vascular lesions are considered features of acute T‐cell‐mediated rejection yet can occur in the absence of tubulointerstitial inflammation, termed isolated ‘v’ lesions. The clinical significance of these lesions is unclear. The diagnosis requires a biopsy with the presence of arteries. The frequency of adequate biopsies was analysed in 89 renal transplant biopsies from 57 paediatric renal allograft recipients, and the incidence of isolated endarteritis was determined. 60 (67%) biopsies contained an artery and of these, isolated ‘v’ lesions occurred in 6 (10%). 5 (83%) biopsies with isolated ‘v’ lesions were associated with positive DSA, suggesting that these lesions may represent acute antibody‐mediated rejection. Patients with vessel‐negative biopsies had an increased decline in eGFR (median −20.5, IQR −24.4 to 1.2 ml/min/1.73 m2 vs. −9.6, IQR −78.7 to −6.8 ml/min/1.73 m2; P = 0.01). Patients with vessel‐negative biopsies were more likely to have repeat biopsy for ongoing allograft dysfunction, (25.0% vs. 2.4%; P |
| doi_str_mv | 10.1111/tri.12227 |
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Intimal vascular lesions are considered features of acute T‐cell‐mediated rejection yet can occur in the absence of tubulointerstitial inflammation, termed isolated ‘v’ lesions. The clinical significance of these lesions is unclear. The diagnosis requires a biopsy with the presence of arteries. The frequency of adequate biopsies was analysed in 89 renal transplant biopsies from 57 paediatric renal allograft recipients, and the incidence of isolated endarteritis was determined. 60 (67%) biopsies contained an artery and of these, isolated ‘v’ lesions occurred in 6 (10%). 5 (83%) biopsies with isolated ‘v’ lesions were associated with positive DSA, suggesting that these lesions may represent acute antibody‐mediated rejection. Patients with vessel‐negative biopsies had an increased decline in eGFR (median −20.5, IQR −24.4 to 1.2 ml/min/1.73 m2 vs. −9.6, IQR −78.7 to −6.8 ml/min/1.73 m2; P = 0.01). Patients with vessel‐negative biopsies were more likely to have repeat biopsy for ongoing allograft dysfunction, (25.0% vs. 2.4%; P < 0.01). The data suggest that isolated ‘v’ lesions are more common than previously thought. A significant proportion of biopsies classified as ‘normal’ or ‘borderline change’ in the absence of a large vessel may represent undiagnosed acute rejection. This may result in suboptimal therapy with possible adverse effects on renal outcome.</description><identifier>ISSN: 0934-0874</identifier><identifier>EISSN: 1432-2277</identifier><identifier>DOI: 10.1111/tri.12227</identifier><identifier>PMID: 24329984</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adolescent ; allograft rejection ; Antibodies - chemistry ; Arteries - chemistry ; Arteritis - physiopathology ; Banff schema ; Biopsy - methods ; Child ; Child, Preschool ; Female ; Glomerular Filtration Rate ; Graft Rejection - diagnosis ; Graft Rejection - pathology ; Humans ; Infant ; Inflammation ; Kidney - blood supply ; Kidney - pathology ; Kidney Transplantation - methods ; Male ; Renal Insufficiency - immunology ; Renal Insufficiency - therapy ; Retrospective Studies ; Tissue Donors ; Treatment Outcome ; vascular rejection</subject><ispartof>Transplant international, 2014-02, Vol.27 (2), p.170-175</ispartof><rights>2013 Steunstichting ESOT. Published by John Wiley & Sons Ltd</rights><rights>2013 Steunstichting ESOT. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2014 Steunstichting ESOT</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3887-46b69e7380a16a6326e22eebba1d4311adced25eeb9c3effab6fcb3c0d1cd4913</citedby><cites>FETCH-LOGICAL-c3887-46b69e7380a16a6326e22eebba1d4311adced25eeb9c3effab6fcb3c0d1cd4913</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%2Ftri.12227$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftri.12227$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24329984$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brown, Chrysothemis C.</creatorcontrib><creatorcontrib>Sebire, Neil J.</creatorcontrib><creatorcontrib>Wittenhagen, Per</creatorcontrib><creatorcontrib>Shaw, Olivia</creatorcontrib><creatorcontrib>Marks, Stephen D.</creatorcontrib><title>Clinical significance of isolated v lesions in paediatric renal transplant biopsies: muscular arteries required to refute the diagnosis of acute rejection</title><title>Transplant international</title><addtitle>Transpl Int</addtitle><description>Summary
Intimal vascular lesions are considered features of acute T‐cell‐mediated rejection yet can occur in the absence of tubulointerstitial inflammation, termed isolated ‘v’ lesions. The clinical significance of these lesions is unclear. The diagnosis requires a biopsy with the presence of arteries. The frequency of adequate biopsies was analysed in 89 renal transplant biopsies from 57 paediatric renal allograft recipients, and the incidence of isolated endarteritis was determined. 60 (67%) biopsies contained an artery and of these, isolated ‘v’ lesions occurred in 6 (10%). 5 (83%) biopsies with isolated ‘v’ lesions were associated with positive DSA, suggesting that these lesions may represent acute antibody‐mediated rejection. Patients with vessel‐negative biopsies had an increased decline in eGFR (median −20.5, IQR −24.4 to 1.2 ml/min/1.73 m2 vs. −9.6, IQR −78.7 to −6.8 ml/min/1.73 m2; P = 0.01). Patients with vessel‐negative biopsies were more likely to have repeat biopsy for ongoing allograft dysfunction, (25.0% vs. 2.4%; P < 0.01). The data suggest that isolated ‘v’ lesions are more common than previously thought. A significant proportion of biopsies classified as ‘normal’ or ‘borderline change’ in the absence of a large vessel may represent undiagnosed acute rejection. This may result in suboptimal therapy with possible adverse effects on renal outcome.</description><subject>Adolescent</subject><subject>allograft rejection</subject><subject>Antibodies - chemistry</subject><subject>Arteries - chemistry</subject><subject>Arteritis - physiopathology</subject><subject>Banff schema</subject><subject>Biopsy - methods</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Graft Rejection - diagnosis</subject><subject>Graft Rejection - pathology</subject><subject>Humans</subject><subject>Infant</subject><subject>Inflammation</subject><subject>Kidney - blood supply</subject><subject>Kidney - pathology</subject><subject>Kidney Transplantation - methods</subject><subject>Male</subject><subject>Renal Insufficiency - immunology</subject><subject>Renal Insufficiency - therapy</subject><subject>Retrospective Studies</subject><subject>Tissue Donors</subject><subject>Treatment Outcome</subject><subject>vascular rejection</subject><issn>0934-0874</issn><issn>1432-2277</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1u1DAQgC1ERZfCgRdAlrjQQ1r_rZNwQysKlSohVe05cpxJ8cobpx6nqK_C0zLLFg5I9WVGo8_faGYYeyfFmaR3XnI4k0qp-gVbSaNVRWn9kq1Eq00lmtocs9eIWyGEatbiFTtWBLVtY1bs1yaGKXgXOYa7KYyUTh54GnnAFF2BgT_wCBjShDxMfHYwBEcNPc8w0beS3YRzdFPhfUgzBsBPfLegX6LL3OUCmUoE3y8hk60kyselAC8_gJPrbkoYcN_R-X05wxZ8oX5v2NHoIsLbp3jCbi--3Gy-VVffv15uPl9VXjdNXRnb2xZq3QgnrbNaWVAKoO-dHIyW0g0eBrWmSus1jKPr7eh77cUg_WBaqU_Yx4N3zul-ASzdLqCHSDNBWrCTphW1lfVaEfrhP3SblkxrIMpasdamkXvh6YHyOSHStN2cw87lx06Kbn-wjvbX_TkYse-fjEu_g-Ef-fdCBJwfgJ8hwuPzpu7m-vKg_A1YaqPA</recordid><startdate>201402</startdate><enddate>201402</enddate><creator>Brown, Chrysothemis C.</creator><creator>Sebire, Neil J.</creator><creator>Wittenhagen, Per</creator><creator>Shaw, Olivia</creator><creator>Marks, Stephen D.</creator><general>Blackwell Publishing Ltd</general><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>7QO</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201402</creationdate><title>Clinical significance of isolated v lesions in paediatric renal transplant biopsies: muscular arteries required to refute the diagnosis of acute rejection</title><author>Brown, Chrysothemis C. ; Sebire, Neil J. ; Wittenhagen, Per ; Shaw, Olivia ; Marks, Stephen D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3887-46b69e7380a16a6326e22eebba1d4311adced25eeb9c3effab6fcb3c0d1cd4913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>allograft rejection</topic><topic>Antibodies - chemistry</topic><topic>Arteries - chemistry</topic><topic>Arteritis - physiopathology</topic><topic>Banff schema</topic><topic>Biopsy - methods</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Graft Rejection - diagnosis</topic><topic>Graft Rejection - pathology</topic><topic>Humans</topic><topic>Infant</topic><topic>Inflammation</topic><topic>Kidney - blood supply</topic><topic>Kidney - pathology</topic><topic>Kidney Transplantation - methods</topic><topic>Male</topic><topic>Renal Insufficiency - immunology</topic><topic>Renal Insufficiency - therapy</topic><topic>Retrospective Studies</topic><topic>Tissue Donors</topic><topic>Treatment Outcome</topic><topic>vascular rejection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brown, Chrysothemis C.</creatorcontrib><creatorcontrib>Sebire, Neil J.</creatorcontrib><creatorcontrib>Wittenhagen, Per</creatorcontrib><creatorcontrib>Shaw, Olivia</creatorcontrib><creatorcontrib>Marks, Stephen D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brown, Chrysothemis C.</au><au>Sebire, Neil J.</au><au>Wittenhagen, Per</au><au>Shaw, Olivia</au><au>Marks, Stephen D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical significance of isolated v lesions in paediatric renal transplant biopsies: muscular arteries required to refute the diagnosis of acute rejection</atitle><jtitle>Transplant international</jtitle><addtitle>Transpl Int</addtitle><date>2014-02</date><risdate>2014</risdate><volume>27</volume><issue>2</issue><spage>170</spage><epage>175</epage><pages>170-175</pages><issn>0934-0874</issn><eissn>1432-2277</eissn><abstract>Summary
Intimal vascular lesions are considered features of acute T‐cell‐mediated rejection yet can occur in the absence of tubulointerstitial inflammation, termed isolated ‘v’ lesions. The clinical significance of these lesions is unclear. The diagnosis requires a biopsy with the presence of arteries. The frequency of adequate biopsies was analysed in 89 renal transplant biopsies from 57 paediatric renal allograft recipients, and the incidence of isolated endarteritis was determined. 60 (67%) biopsies contained an artery and of these, isolated ‘v’ lesions occurred in 6 (10%). 5 (83%) biopsies with isolated ‘v’ lesions were associated with positive DSA, suggesting that these lesions may represent acute antibody‐mediated rejection. Patients with vessel‐negative biopsies had an increased decline in eGFR (median −20.5, IQR −24.4 to 1.2 ml/min/1.73 m2 vs. −9.6, IQR −78.7 to −6.8 ml/min/1.73 m2; P = 0.01). Patients with vessel‐negative biopsies were more likely to have repeat biopsy for ongoing allograft dysfunction, (25.0% vs. 2.4%; P < 0.01). The data suggest that isolated ‘v’ lesions are more common than previously thought. A significant proportion of biopsies classified as ‘normal’ or ‘borderline change’ in the absence of a large vessel may represent undiagnosed acute rejection. This may result in suboptimal therapy with possible adverse effects on renal outcome.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>24329984</pmid><doi>10.1111/tri.12227</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent allograft rejection Antibodies - chemistry Arteries - chemistry Arteritis - physiopathology Banff schema Biopsy - methods Child Child, Preschool Female Glomerular Filtration Rate Graft Rejection - diagnosis Graft Rejection - pathology Humans Infant Inflammation Kidney - blood supply Kidney - pathology Kidney Transplantation - methods Male Renal Insufficiency - immunology Renal Insufficiency - therapy Retrospective Studies Tissue Donors Treatment Outcome vascular rejection |
| title | Clinical significance of isolated v lesions in paediatric renal transplant biopsies: muscular arteries required to refute the diagnosis of acute rejection |
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