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Isolated v-lesion in kidney transplant recipients: Characteristics, association with DSA, and histological follow-up.

Rabant, Marion; Boullenger, Fanny; Gnemmi, Viviane; Pellé, Gaëlle; Glowacki, François; Hertig, Alexandre; Brocheriou, Isabelle; Suberbielle, Caroline; Taupin, Jean-Luc; Anglicheau, Dany; Legendre, Christophe; Duong Van Huyen, Jean-Paul; Buob, David.
Am J Transplant; 18(4): 972-981, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29206350
Isolated v-lesion (IvL) represents a rare and challenging situation in renal allograft biopsies because it is unknown whether IvL truly represents rejection, antibody- or T cell-mediated, or not. This multicentric retrospective study describes the clinicopathological features of IvL with an emphasis on the donor-specific antibody (DSA) status, histological follow-up, and graft survival. Inclusion criteria were the presence of v-lesion with minimal interstitial (i ≤ 1) and microvascular inflammation (g + ptc≤1). C4d-positive biopsies were excluded. We retrospectively found 33 IvL biopsies in 33 patients, mainly performed in the early posttransplantation period (median time 27 days) and clinically indicated in 66.7%. A minority of recipients (5/33, 15.2%) had DSA at the time of biopsy. IvL was treated by anti-rejection therapy in 21 cases (63.6%), whereas 12 (36.4%) were untreated. Seventy percent of untreated patients and 66% of treated patients showed favorable histological evolution on subsequent biopsy. Kidney graft survival in IvL was significantly higher than in a matched cohort of antibody-mediated rejection with arteritis. In conclusion, IvL is not primarily antibody-mediated and may show a favorable evolution. The heterogeneity of IvL pathophysiology on early biopsies should prompt DSA testing as well as close clinical and histological follow-up in all patients with IvL.
Selo DaSilva