Re-evaluation of glomerulitis using occlusion criteria based on the Banff 2013 revision: a retrospective study

Ozluk Y., Caliskan Y., Sevinc M., Bayram A., Arikan E., Turkmen A., ...Daha Fazla

TRANSPLANT INTERNATIONAL, cilt.30, sa.6, ss.579-588, 2017 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 30 Sayı: 6
  • Basım Tarihi: 2017
  • Doi Numarası: 10.1111/tri.12943
  • Dergi Adı: TRANSPLANT INTERNATIONAL
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.579-588
  • Anahtar Kelimeler: Banff classification, biopsy, glomerulitis, renal transplant, ANTIBODY-MEDIATED REJECTION, RENAL-ALLOGRAFT REJECTION, TRANSPLANT GLOMERULOPATHY, KIDNEY-TRANSPLANTS, PROTOCOL BIOPSIES, CLASSIFICATION, PATHOLOGY, REPRODUCIBILITY, INFLAMMATION, CELLS
  • İstanbul Üniversitesi Adresli: Evet

Özet

The presence of occlusion/near-occlusion of glomerular capillaries was recently added to the existing definition of glomerulitis (g). We retrospectively re-evaluated 135 renal allograft biopsies regarding g to ensure no antibody-damaged grafts were missed. Previous and revised g scores (pg and rg, respectively) were compared for clinicopathologic correlations. The g score did not change in 100 (74.1%) biopsies. Thirty-five (25.9%) biopsies were changed to a lower score. Sensitivity and specificity of pg and rg for the presence of donor-specific antibodies (DSA) were 76% vs. 58% and 70% vs. 79%, respectively. Pg score indicated graft loss with 65% sensitivity and 63% specificity, whereas rg showed 46% sensitivity and 71% specificity. Area under the curve (AUC) values in ROC analysis for DSA and graft loss were as follows: pg, 0.773; rg, 0.693; and pg, 0.635; rg, 0.577, respectively. A comparison of the two AUC values revealed a significant difference between pg and rg only for DSA (P=0.0076). Pg and post-transplant time of biopsy independently predicted graft loss, whereas rg did not. In conclusion, revised g scores showed lesser sensitivity but higher specificity for DSA and graft loss. Recent definition of g missed antibody-mediated rejection in few cases, and it was not an independent predictor for graft loss.