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Sandesh Parajuli, Robert R Redfield, Neetika Garg, Fahad Aziz, Maha Mohamed, Brad C Astor, Weixong Zhong, Arjang Djamali, Didier A Mandelbrot
BACKGROUND: Limited information exists about outcomes of HLA DSA negative (DSA-) microvascular inflammation (MVI). METHODS: We report our experience with 25 DSA- patients with MVI compared to 155 DSA+ patients who met Banff 2013 criteria for ABMR. We also compared outcomes to 228 DSA+ patients whose biopsies were negative for rejection, and served as a negative control. RESULTS: There were no significant differences in the baseline characteristics between the DSA- MVI and DSA+ ABMR groups...
October 17, 2018: Transplantation
M Shrestha, D Singh, M R Sigdel, M P Kafle
BACKGROUND: Increasing graft survival is the prime focus of every transplantation program. Detection of subclinical abnormalities with the help of protocol renal graft biopsies performed at predetermined intervals after transplantation has been one of the approaches. The objective was to study the abnormalities in protocol renal graft biopsy specimens at 6 months posttransplantation. METHODS: This was a hospital-based observational descriptive study. It included the recipients who underwent kidney transplantation between October 2014 and September 2015...
October 2018: Transplantation Proceedings
Daniela Ramos, Archivaldo Reche-Junior, Daniel S Mills, Priscila L Fragoso, Alexandre Gt Daniel, Mariana F Freitas, Silvia G Cortopassi, Geni Patricio
Objective The aim was to perform a case-control medical evaluation of cats from multi-cat households presenting with inappropriate latrining and spraying behavior. Methods Owners of 18 'spraying' and 23 'latrining' cats with normal control subjects available from the same households were recruited for a case-control study. Otherwise overtly healthy dyads (each dyad consisting of a case cat and a control cat) were brought together to the veterinary hospital of the University of São Paulo for a medical work-up (ie, physical examination, complete blood count, biochemical profile, urinalysis and urine culture, abdominal ultrasound of the urinary system and in females, where possible, cystoscopy)...
September 28, 2018: Journal of Feline Medicine and Surgery
Alberto Mella, Ester Gallo, Maria Messina, Cristiana Caorsi, Antonio Amoroso, Paolo Gontero, Aldo Verri, Francesca Maletta, Antonella Barreca, Fabrizio Fop, Luigi Biancone
AIM: To evaluate the role of a therapeutic regimen with plasma exchange, intravenous immunoglobulins and rituximab in chronic-active antibody-mediated rejection (cAMR) settings. METHODS: We compared 21 kidney transplant recipients (KTRs) with a diagnosis of cAMR in a retrospective case-control analysis: nine KTRs treated with plasmapheresis, intravenous immunoglobulins and rituximab (PE-IVIG-RTX group) vs 12 patients (control group) not treated with antibody-targeted therapies...
September 10, 2018: World Journal of Transplantation
Byron Smith, Lynn D Cornell, Maxwell Smith, Cherise Cortese, Xochiquetzal Geiger, Mariam P Alexander, Margaret Ryan, Walter Park, Martha Catalina Morales Alvarez, Carrie Schinstock, Walter Kremers, Mark Stegall
Poor reproducibility in scoring antibody-mediated rejection (ABMR) using the Banff criteria might limit the use of histology in clinical trials. We evaluated the reproducibility of Banff scoring of 67 biopsies by six renal pathologists at three institutions. Agreement by any two pathologists was poor: 44.8-65.7% for glomerulitis, 44.8-67.2% for peritubular capillaritis, and 53.7-80.6% for chronic glomerulopathy (cg). All pathologists agreed on cg0 (n = 20) and cg3 (n = 9) cases, however, many disagreed on scores of cg1 or cg2...
September 4, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Mark Haas
The Banff classification of renal allograft pathology defines specific morphologic lesions that are used in the diagnosis of active (glomerulitis, peritubular capillaritis, endarteritis) and chronic (transplant glomerulopathy, peritubular capillary basement membrane multilayering, transplant arteriopathy) antibody-mediated rejection (ABMR). However, none of these individual lesions are specific for ABMR, and for this reason Banff requires one or more additional findings, including C4d deposition in peritubular capillaries, presence of circulating donor-specific antibodies (DSA), and/or expression in the tissue of transcripts strongly associated with ABMR, for a definitive diagnosis of ABMR to be made...
August 22, 2018: American Journal of Transplantation
Andriy V Trailin, Tamara N Nykonenko, Tetyana I Ostapenko, Sergiy R Vildanov, Olexandr S Nykonenko
OBJECTIVES: Our aim was to evaluate which histologic lesions in a donor kidney were associated with graft function up to 5 years and with its dynamics. MATERIALS AND METHODS: We retrospectively investigated the association between acute and chronic individual histologic lesions and composite scores in preimplant and postreperfusion biopsies from deceased-donor (n = 101) and living-donor (n = 29) kidneys with initial graft function and function at discharge, at 6 months, and at 5 years and slopes of estimated glomerular filtration rate from discharge to 6 months and from 6 months to 5 years...
August 17, 2018: Experimental and Clinical Transplantation
Nicolas Kozakowski, Harald Herkner, Farsad Eskandary, Michael Eder, Wolfgang Winnicki, Johannes Kläger, Gregor Bond, Željko Kikic
Background: Peritubular capillaritis (ptc), reported by the ptc score, is a major feature of kidney allograft rejection and microvascular inflammation (MVI). MVI sum scores (ptc + glomerulitis score ≥2) are accepted diagnostic surrogates of human leucocyte antigen (HLA)-antibody interaction. However, low-grade inflammation is common and ptc scores (number of leucocytes/capillary) may not mirror all aspects of ptc morphology. Recently we observed a relationship of the diffuse extent of ptc (inflammation of >50% of the renal cortex) with graft loss and significantly higher donor-specific antibody levels, suggesting potential inclusion of diffuse ptc as an additional surrogate of antibody-antigen interaction...
July 20, 2018: Nephrology, Dialysis, Transplantation
Daqiang Zhao, Tao Liao, Siwen Li, Yannan Zhang, Haofeng Zheng, Jing Zhou, Fei Han, Yu Dong, Qiquan Sun
Antibody-mediated rejection (AMR) is the main barrier to renal graft survival, and mouse renal AMR models are important to study this process. Current mouse models are established by priming the recipient to donor skin for over 7 days before kidney transplantation. The robustness of AMR in these cases is too strong to mimic clinical AMR and it is unclear why altering the priming times ranging from 7 to 91 days fails to reduce the AMR potency in these models. In the present study, we found that the donor-recipient combination and skin graft size were determinants of donor-specific antibody (DSA) development patterns after skin transplantation...
2018: Frontiers in Immunology
Shigeo Hara
The Banff histopathology classification system is the gold standard for assessing the causes of kidney allograft dysfunction triggered by antibody-mediated and T-cell-mediated immune reactions, thereby providing mechanistic insight and guiding therapeutic decisions. The original Banff classification (1993) consisted of four histological categories representing cell-mediated rejection: interstitial inflammation (i), tubulitis (t), endoarteritis (v), and transplant glomerulitis (g). The revised Banff 2007 classification added total inflammation score (ti) from both scarred and unscarred areas based on evolving interpretations of interstitial infiltrates...
July 2018: Nephrology
Aki Mafune Hamada, Izumi Yamamoto, Mayuko Kawabe, Haruki Katsumata, Takafumi Yamakawa, Ai Katsuma, Yasuyuki Nakada, Akimitsu Kobayashi, Yusuke Koike, Jun Miki, Hiroki Yamada, Takahiro Kimura, Yudo Tanno, Ichiro Ohkido, Nobuo Tsuboi, Hiroyasu Yamamoto, Takashi Yokoo
Plasma cell-rich acute rejection (PCAR) is a rare type of acute rejection in renal transplantation. Despite aggressive immunotherapy, approximately 40-60% of patients develop graft loss within 1 year after an episode of PCAR. However, the reason for this outcome remains obscure. This study retrospectively identified six patients with PCAR diagnosed between 2009 and 2015 at a single university hospital. Clinicopathological data were collected. Five of the six patients were male, and mean age at the onset of PCAR was 49...
July 2018: Nephrology
Ken Sakai, Hideyo Oguchi, Masaki Muramatsu, Seiichiro Shishido
Accurate interpretation of renal allograft biopsy is necessary to guide therapy, especially when an episode biopsy is taken to rescue the graft. Contrarily, a protocol biopsy is carried out routinely to identify baseline conditions (biopsy at 0 or 1 h), subclinical rejection, histological change under current immunosuppression regimen, drug nephrotoxicity, viral infection, and recurrence of glomerulonephritis. Semiquantitative scoring for active lesions including tubulitis, glomerulitis, capillaritis, arteritis, arteriopathy, and others such as polyomavirus infection are key factors in transplant pathology...
July 2018: Nephrology
Filiz Mercantepe, Tolga Mercantepe, Atilla Topcu, Adnan Yılmaz, Levent Tumkaya
Despite the enormous advances made in the field of oncology, no solution to the side effect of nephrotoxicity caused by cisplatin used as an antineoplastic agent for approximately 40 years has yet been discovered. This study investigated the effects of cisplatin on the kidney, the damage mechanism involved, and the potential capacity of agents such as amifostine, curcumin, and melatonin to elicit a future therapeutic protocol in cisplatin-induced nephrotoxicity at the ultrastructural and molecular levels. Our study consisted of five groups: control (saline solution only; group 1), cisplatin (cisplatin only; group 2), cisplatin + amifostine (group 3), cisplatin + curcumin (group 4), and cisplatin + melatonin (group 5)...
September 2018: Naunyn-Schmiedeberg's Archives of Pharmacology
Denis Viglietti, Yassine Bouatou, Vissal David Kheav, Olivier Aubert, Caroline Suberbielle-Boissel, Denis Glotz, Christophe Legendre, Jean-Luc Taupin, Adriana Zeevi, Alexandre Loupy, Carmen Lefaucheur
A major hurdle to improving clinical care in the field of kidney transplantation is the lack of biomarkers of the response to antibody-mediated rejection (ABMR) treatment. To discover these we investigated the value of complement-binding donor-specific anti-HLA antibodies (DSAs) for evaluating the response to treatment. The study encompassed a prospective cohort of 139 kidney recipients with ABMR receiving the standard of care treatment, including plasma exchange, intravenous immunoglobulin and rituximab. Patients were systematically assessed at the time of diagnosis and three months after treatment initiation for clinical and allograft histological characteristics and anti-HLA DSAs, including their C1q-binding ability...
October 2018: Kidney International
J Kim, S-E Choi, B J Lim, Y S Kim, K H Huh, J Lee, S I Kim, M S Kim, H J Jeong
BACKGROUND: The significance of proinflammatory M1 (classically activated) and profibrotic M2 (alternatively activated) macrophages in antibody-mediated rejection (ABMR) after kidney transplantation has not been investigated. METHODS: Fifty-five biopsy-confirmed ABMR samples were stained with MRP 8/14 (a marker of M1 macrophages) and CD163 (a marker of M2 macrophages), and positive cells were counted in glomeruli and the tubulointerstitium, respectively. Patients were classified into M1 and M2 polarization groups according to the glomerular and tubulointerstitial M1:M2 ratio, and the results were compared with Banff scores, serum creatinine level, estimated glomerular filtration rate (eGFR), and graft survival...
May 2018: Transplantation Proceedings
Jing Wang, Li Meng Chen
Primary Sjögren syndrome,characterized by autoimmune epithelitis,is a prevalent systemic autoimmune disease involving multiple organs,among which kidney is a major target organ.Tubulointerstitial lesion is the most frequent form,involving proximal tubule,distal tubule,or collecting duct.The disease has an occult onset and may progressively develop into renal function impairment and end-stage renal disease,which can be accompanied with low-molecular-weight proteinuria,renal tubule acidosis and electrolyte disturbance...
April 28, 2018: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Jumpei Hasegawa, Sachiko Wakai, Momoko Kono, Yusuke Imaizumi, Sakiko Masuda, Akihiro Ishizu, Kazuho Honda
Anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis (AAV) and cryoglobulinemic vasculitis (CV) rarely coexist. An 83-year-old woman was admitted with rapidly progressive renal failure, gastrointestinal hemorrhage and purpura with myeloperoxidase (MPO) -ANCA positivity and cryoglobulinemia. Despite intensive immunosuppressive treatment, she died of aspergillus pneumonia. Autopsy revealed necrotizing crescentic glomerulitis in the majority of the glomeruli, accompanied by partially membranoproliferative-like glomerular changes...
April 27, 2018: Internal Medicine
Eduardo Vazquez Martul
In order to make an objective assessment of the histopathology of a renal biopsy during a kidney transplant, all the various elements involved in the process must be understood. It is important to know the characteristics of the donor organ, especially if the donor is older than 65. The histopathological features of the donor biopsy, especially its vascular status, are often related to an initial poor function of the transplanted kidney. The T lymphocyte inflammatory response is characteristic in acute cellular rejection; the degree of tubulitis, together with the amount of affected parenchyme, are important factors...
April 2018: Revista Española de Patología
Maritere Nazario, Oana Nicoara, Lauren Becton, Sally Self, Jeanne Hill, Elizabeth Mack, Melissa Evans, Katherine Twombley
There is currently no way to diagnose a rejection before a change in serum creatinine. This had led some to start doing SB, but little data exist on the utility and safety of SB in pediatric patients. There is also little known on practice patterns of pediatric nephrologists. A retrospective review of pediatric kidney transplant SB between January 2013 and January 2017 at a single center was performed. A survey went to the PedNeph email list. There were 47 SB; 15 at 6 months, 12 at 1 year, 13 at 2 years, and 7 at 3 years...
June 2018: Pediatric Transplantation
Sandesh Parajuli, Didier A Mandelbrot, Brenda Muth, Maha Mohamed, Neetika Garg, Fahad Aziz, Robert R Redfield, Weixiong Zhong, Brad C Astor, Arjang Djamali
Background: There is limited information on treatment strategies and monitoring strategies for late antibody-mediated rejection (ABMR) after kidney transplantation. Methods: In this observational and nonrandomized study, we compared 78 patients diagnosed with late ABMR (>3 months after transplant) who were treated with standard of care steroids/IVIG (n = 38) ± rituximab (n = 40) at our center between March 1, 2013 and December 31, 2016. All patients had follow-up biopsy and donor-specific antibodies (DSA) monitoring within 3 to 12 weeks...
December 2017: Transplantation Direct
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