In acute rejection after renal transplant, glomerulitis is characterized by mononuclear cells in glomerular capillaries and endothelial cell enlargement. In association with C4d deposition in peritubular capillaries, glomerulitis is a feature of acute antibody-mediated rejection. Prognosis in C4d+ rejection is poorer than in C4d- rejection. We measured the glomerular endothelial cell area in C4d+ and C4d- acute rejections by morphometry. In 90 acute rejection biopsies, glomerulitis was present in 36 cases (group G) and absent in 54 (group G0). In biopsies without rejections and in C4d- biopsies of group G0, glomerular endothelial cell area was not significantly different. In C4d- and C4d + biopsies of group G, the area in inflamed glomeruli was greater than that in C4d- biopsies of group G0 (P <.02 and P <.006, respectively). In C4d+ biopsies of group G0, it was, unexpectedly, greater than in C4d- biopsies of group G (P <.01). Circulating posttransplant anti-human leukocyte antigen class I and class II antibodies correlated with increased endothelial cell area (P <.02). Glomerulitis was associated with diffuse C4d deposition (odds ratio [OR], 4.27; P <.004); C4d deposition was associated with steroid resistance (OR, 4.97; P <.002). Only in C4d+ rejections did the presence of glomerulitis increase this association (OR, 9.17; P <.02). In conclusion, we quantified an increase of endothelial cell area in glomerulitis of C4d+ and C4d- acute rejections (group G). An increase of this area in C4d+ biopsies without glomerulitis (group G0) suggests complement-mediated damage in the absence of mononuclear cell margination
Glomerulitis and endothelial cell enlargement in c4d+ and c4d- acute rejections of renal transplant patients
AIELLO, Francesca Bianca;
2012-01-01
Abstract
In acute rejection after renal transplant, glomerulitis is characterized by mononuclear cells in glomerular capillaries and endothelial cell enlargement. In association with C4d deposition in peritubular capillaries, glomerulitis is a feature of acute antibody-mediated rejection. Prognosis in C4d+ rejection is poorer than in C4d- rejection. We measured the glomerular endothelial cell area in C4d+ and C4d- acute rejections by morphometry. In 90 acute rejection biopsies, glomerulitis was present in 36 cases (group G) and absent in 54 (group G0). In biopsies without rejections and in C4d- biopsies of group G0, glomerular endothelial cell area was not significantly different. In C4d- and C4d + biopsies of group G, the area in inflamed glomeruli was greater than that in C4d- biopsies of group G0 (P <.02 and P <.006, respectively). In C4d+ biopsies of group G0, it was, unexpectedly, greater than in C4d- biopsies of group G (P <.01). Circulating posttransplant anti-human leukocyte antigen class I and class II antibodies correlated with increased endothelial cell area (P <.02). Glomerulitis was associated with diffuse C4d deposition (odds ratio [OR], 4.27; P <.004); C4d deposition was associated with steroid resistance (OR, 4.97; P <.002). Only in C4d+ rejections did the presence of glomerulitis increase this association (OR, 9.17; P <.02). In conclusion, we quantified an increase of endothelial cell area in glomerulitis of C4d+ and C4d- acute rejections (group G). An increase of this area in C4d+ biopsies without glomerulitis (group G0) suggests complement-mediated damage in the absence of mononuclear cell marginationI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
