ACUTE RENAL ALLOGRAFT REJECTION WITH SEVERE TUBULITIS (BANFF 1997
GRADE
IB)
Index
Marta Ida Minervini, Michael Torbenson, Velma Scantlebury,
Carlos
Vivas,
Mark Jordan, Ron Shapiro, and Parmjeet S Randhawa
Divisions of Transplantation Pathology (MIM,MT,PSR), Transplantation Surgery (VS,RS) and
Urologic
Surgery (CV,MJ), Departments of Pathology, and Surgery, and the Thomas E
Starzl
Transplantation Institute, University of Pittsburgh Medical Center,
Pittsburgh,
PA, USA
Background
Several recent studies have attempted to correlate renal
allograft
function with individual histologic lesions defined in the Banff
Schema of
kidney transplantation pathology. The clinical significance of severe
tubulitis
(Banff 97 grade t3) has not been specifically examined. We compare the
clinical
course and response to anti-rejection therapy in 36 patients with
severe
grade
t3 tubulitis, and 51 patients with grade V1 intimal arteritis.
Methods
Cases were selected from a computerized database, and kidney
biopsies
were evaluated using the Banff 1997 Schema of renal allograft
pathology.
Histologic parameters were correlated with clinical data and analyzed
for
statistical significance.
Results
Rejection associated with severe tubulitis (Banff 97 Type
IB),
occurred
later in the post-transplant course, but was otherwise comparable to
rejection
associated with grade v1 intimal arteritis (Banff 97 Type IIA), in
terms
of (a)
reversibility of rejection episodes, (b) serum creatinine 12 months
following
diagnosis, and (c) rate of graft loss. Rejection characterized by
intimal
arteritis of grade v2 (Banff 97 Type IIB) or v3 (Banff 97 Type III)
led to
significantly worse graft outcome.
Conclusion
The presence of grade t3 tubulitis in renal allograft
biopsies
should be a cause for clinical concern. No significant difference in
graft
failure at 1 year was seen between t3 tubulitis and v1 intimal
arteritis
(p=0,795). The long term sequelae of severe tubular injury need to be
defined by
future studies.
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