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. 2019 Sep;19(9):2434-2445.
doi: 10.1111/ajt.15340. Epub 2019 Apr 8.

Markers of graft microvascular endothelial injury may identify harmful donor-specific anti-HLA antibodies and predict kidney allograft loss

Kevin Louis  1 , Alexandre Hertig  1   2 , Jean-Luc Taupin  3 , David Buob  2   4 , Matthieu Jamme  1 , Isabelle Brocheriou  2   5 , Yosu Luque  1   2 , Chantal Jouanneau  1 , Nacera Ouali  1 , Marie Audouin  6 , Eric Rondeau  1   2 , Yi-Chun Xu-Dubois  1   7
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Free article

Markers of graft microvascular endothelial injury may identify harmful donor-specific anti-HLA antibodies and predict kidney allograft loss

Kevin Louis et al. Am J Transplant. 2019 Sep.
Free article

Abstract

Graft microvasculature is a major target of donor-specific antibodies (DSA) and endothelial damage is direct evidence of antibody-mediated rejection (ABMR). Using immunohistochemistry, we analyzed the expression of three microvascular endothelial activation markers (fascin, vimentin, and hsp47), suggestive of endothelial-to-mesenchymal transition (EndMT) in 351 graft biopsies from 248 kidney recipients, with concomitant screening of circulating antihuman leukocyte antigen (HLA) DSA at the time of the biopsy. The factors associated with EndMT marker expression were DSA and the presence of microvascular inflammation (MI). EndMT expressing grafts had significantly more allograft loss compared to EndMT negative grafts (P < .0001). The expression of EndMT markers positively correlated with anti-HLA DSA class II mean fluorescence intensity (MFI) levels and especially identified DQ and DR antibodies as being more closely associated with microvascular injury. Moreover, only DSA linked to positive EndMT score affected allograft survival, regardless of DSA MFI levels or presence of C4d deposition. Thus, EndMT markers could represent a clinically relevant tool for early identification of ongoing endothelial injury, harmful DSA, and patients at high risk for allograft failure.

Keywords: kidney biology; kidney transplantation/nephrology; pathology/histopathology; rejection: antibody-mediated (ABMR); risk assessment/risk stratification; translational research/science.

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References

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