Vascular and interstitial features of cellular renal allograft rejection: Effects on therapy and outcome
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:696A 1997
There has been a lot of recent interest in grading acute renal allograft rejection using standardized nomenclature, and correlating the occurrence of objectively defined lesions with ultimate clinical outcome.
Nickeleit et al report their analysis of 111 renal allograft biopsies employing terminology used by the National Institutes of Health Cooperative Clinical Trials in Transplantation (NIH- CCTT). They report that Type 3 rejection, defined by the presence of fibrinoid vascular necrosis, was associated with a significantly worse 1 year graft survival. Patients showing Type 2 rejection, characterized by endothelialitis (transplant arteritis), were steroid resistant but responded satisfactorily to antilymphocyte antibody therapy. The one year graft survival and serum creatinine in these patients was comparable to patients with Type 1 rejection, defined as the occurrence of tubulitis not accompanied by endothelialitis.
Comment: The data presented validates the use of vascular changes in the grading of acute rejection, as has been suggested by both the NIH-CCTT and Banff Schemas of renal allograft pathology. The lack of observed difference in the clinical outcome between Type 1 and Type 2 rejection may reflect the relatively short follow-up of patients, and the reliance on serum creatinine as the only marker for assessing graft function. (Parmjeet Randhawa, M.D., Presbyterian-University Hospital, Pittsburgh, PA)
References:
Solez K, Axelsen RA, Benediktsson H et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Banff working classification of kidney transplant pathology. Kidney Int 1993;44:411-422.
Colvin RB. The renal allograft biopsy. Kidney Int 1996;50:1069-1082.
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ASN 30th Annual Meeting, San Antonio
Transplant : Transplantation