Microvascular inflammation as a prognostic factor in kidney transplantation

THE AIM: to evaluate the association of microvascular inflammation (MVI) and its components (glomerulitis (G) and peritubular capillaritis (PTC)) with the long-term prognosis of renal allograft (RA). PATIENTS AND METHODS: Among 1270 recipients of RA 127 MVI cases with morphological features of G (±PTC) were enrolled into the study, including following groups: 1) G with positive DSA at the biopsy (n=31); 2) G with negative DSA (G+DSA-; n=62); 3) G with undetermined DSA (n=34). According to the presence of T-cell mediated rejection (TCMR) G+DSA- group was further subdivided into: 1) isolated G (isG, n=28); 2) G with concomitant TCMR types IA/B or IIA/B (G+TCMR, n=34). The control groups matched for age, HLA mismatch, year and type of RA included recipients without any rejection (n=92) and with TCMR types IA/B or IIA/B without G (n=65). All recipients enrolled into the study (n=284) were divided into following groups: 1) PTC+G+ (n=83); 2) PTC+G- (n=23); 3) PTC-G+ (n=44); 4) PTC-G- (n=144). Kaplan-Meier survival curves and multivariate Cox regression analysis were applied to estimate the association of MVI, including G and PTC with the risk of graft loss. The median follow-up was 39 (13; 77) months. RESULTS: The RA survival was significantly lower in the presence of MVI (plog-rank <0,001). There were no differences in survival in PTC+G- group and controls without MVI. The presence of G associated with inferior long-term survival irrespectively of presence or absence of PTC. RA survival in G+TCMR was lower than in TCMR without G (plog-rank=0,021). The presence of G was associated with 4,5-5,4-fold increase of related risks of graft loss in multivariable Cox regression analyses, while PTC was not identified as independent predictor of graft survival. CONCLUSION: The prognostic significance of MVI is mainly determined by the presence of G independently associated with RA survival. The early post-transplant diagnostic of G is important for the assessment of prognosis and modification of therapy.

microvascular inflammation, glomerulitis, peritubular capillaritis, donor-specific antibodies

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