RESUMEN
AIMS: To identify the histopathological features of transplant nephrectomy (TN) specimens. METHODS: We performed retrospective analysis of 73 nephrectomies to review the histopathology in detail and correlate the Banff grading characteristics of TN specimens with time post engraftment and clinical features. Retrospective data on donor-specific antibodies (DSA) were also collected. RESULTS: The majority of patients who had TN in less than 3 months posttransplant (n = 20; median time to TN: 4 days) had hemorrhagic infarction; 7 patients (35%) had grade 3 acute rejection (AR). Patients who had TN later than 3 months posttransplant (n = 53; median time to TN: 67 months) had AR, grade 2B (21%) and 3 (43%), coexisting with advanced vascular injury in the form of interstitial hemorrhage, extensive interstitial fibrosis and tubular atrophy (IF/TA) as well as the presence of DSAs. Overall, the majority of patients without DSA pre-TN developed DSA post-TN. CONCLUSIONS: Our data revealed extensive inflammation and ongoing immunologic activity in a subset of patients with a failed graft. Careful and individualized approach based on clinical and laboratory data should guide the decision for transplant nephrectomy.
Asunto(s)
Rechazo de Injerto/patología , Hemorragia/patología , Infarto/patología , Enfermedades Renales/patología , Trasplante de Riñón , Riñón/patología , Nefrectomía , Adulto , Anticuerpos/inmunología , Estudios de Cohortes , Femenino , Fibrosis , Rechazo de Injerto/inmunología , Antígenos HLA/inmunología , Humanos , Riñón/irrigación sanguínea , Riñón/inmunología , Enfermedades Renales/inmunología , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
Antibody-mediated rejection (AMR) is a complication of orthotopic heart transplantation. There is no standard for treatment and it is unclear what role monitoring of donor-directed antibodies (DSA) should play in guiding treatment decisions. In this case series, we describe three patients transplanted at our center who developed AMR and received rituximab as one component of the treatment regimen. We found in these three patients that despite clinical resolution of AMR, high levels of class II donor-directed antibodies persisted. We also summarize our retrospective analysis of 110 heart allografts that had pre- and post-transplant DSA measurements with corresponding EMB and immunofluorescence (IF) during 2005-2011. Our analysis of a subpopulation of 50 informative patients (with DSA measurements, EMB, and corresponding IF) revealed that moderate and severe cardiac allograft vasculopathy were identified more frequently in grafts with DSA than compared to those without DSA.
