ArticleJournal of nephrology2025
Kidney transplant arteriopathy revisited.
Article in Journal of nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTransplant arteriopathy involves a spectrum of Leukocyte Common Antigen-positive, hypoelastotic, foam cell intimal fibrosis. Transplant arteriopathy has been associated with both Chronic Active T Cell-Mediated Rejection and Antibody-Mediated Rejection chronicity. Aim of this study was to find clinicopathological correlates of transplant arteriopathy in a single centre retrospective cohort.
methodsWe retrieved 46 biopsies showing transplant arteriopathy from 33 patients, out of a total of 784 biopsies carried out between 2005 and 2014. We retrospectively evaluated Banff Lesion Scores and Additional Diagnostic Parameters as well as the transplant arteriopathy descriptors Leukocyte Common Antigen-positive, hypoelastotic, foam cell, and correlated these findings with clinical data and death-censored transplant survival.
resultsTransplant arteriopathy was frequently associated with antibody-mediated rejection-associated Banff Lesions Scores and Additional Diagnostic Parameters. Hypoelastotic, leukocyte common antigen-positive and foam cell lesions were often combined, with hypoelastotic lesion being the most frequent finding in transplant arteriopathy. Leukocyte common antigen-positive lesion appeared earlier and was associated with Banff Lesion Score v ≥ 1. About half were positive for donor-specific antibodies, about a third had concurrent transplant glomerulopathy, and about a sixth were C4d-positive. Twelve of thirty-three transplants were lost during follow-up, concurrent transplant glomerulopathy was associated with shorter transplant survival.
conclusionsThe frequent coincidence of transplant arteriopathy and indicators of antibody-mediated rejection suggests that this arterial remodelling could indeed be antibody-mediated rejection chronicity. The transplant community should re-examine transplant arteriopathy with an expanded definition including the previously ignored hypoelastotic lesion in order to re-confirm or reject with confidence transplant arteriopathy as Additional Diagnostic Parameter of Antibody-Mediated Rejection chronicity, and to learn about its prognostic and therapeutic implications.
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