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Review
. 2025 Jan 6:37:13464.
doi: 10.3389/ti.2024.13464. eCollection 2024.

Expanding the Scope of Microvascular Inflammation: Unveiling Its Presence Beyond Antibody-Mediated Rejection Into T-Cell Mediated Contexts

Hilal Varol #  1   2 , Anne Wagenmakers #  2 , Konrad Hoeft  3   4 , Jasper Callemeyn  5   6 , Roos Bodewes  2 , Wichor Bramer  7 , Andrew Stubbs  2   8 , Rafael Kramann  3   4 , Maarten Naesens  5   6 , Marian C Clahsen-Van Groningen  1   2   3
Affiliations
Review

Expanding the Scope of Microvascular Inflammation: Unveiling Its Presence Beyond Antibody-Mediated Rejection Into T-Cell Mediated Contexts

Hilal Varol et al. Transpl Int. .

Abstract

Microvascular inflammation (MVI) in kidney transplant biopsies is mainly associated with antibody-mediated rejection (AMR), sparking debate within the Banff Classification of Renal Allograft Pathology regarding its exclusivity. This study reviewed the literature on MVI in T cell-mediated rejection (TCMR) and analyzed MVI in our transplant population. We searched English publications in MEDLINE, Embase, Web of Science, Cochrane, and Google Scholar until June 2024, focusing on glomerulitis (g), peritubular capillaritis (ptc), or MVI in kidney transplant biopsies classified as TCMR. Additionally, we examined g, ptc, and MVI in 69 patients with AMR, TCMR, and no rejection. Our search yielded 541 citations, with 10 studies included, covering 810 TCMR and 156 AMR biopsies. The studies showed g, ptc, and MVI were present in TCMR but were less prevalent and severe than in AMR. In our cohort, AMR had significantly higher g, ptc, and MVI scores compared to aTCMR and ATN, however, aTCMR also displayed MVI. These findings confirm that MVI occurs in aTCMR and should not be exclusively linked to AMR. These findings highlight the need to further explore MVI's significance in TCMR and investigate the inflammatory composition. This could refine the Banff Classification, improving Classification accuracy of kidney transplant pathology assessments.

Keywords: MVI; TCMR; banff classification; histology; kideny transplantation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The timeline of microvascular inflammation (MVI) in Renal Allograft Pathology according to the Banff Classification. AMR, antibody-mediated rejection; TCMR, T cell-mediated rejection; g, glomerulitis; ptc, peritubular capillaritis.
FIGURE 2
FIGURE 2
Summary of study inclusion and exclusion process.
FIGURE 3
FIGURE 3
Differences in glomerulitis, peritubular capillaritis and MVI in active antibody–mediated rejection (aAMR), acute T cell-mediated rejection (aTCMR) and acute tubular necrosis (ATN). (A) Histomorphologic images of aAMR, aTCMR and ATN, respectively, showing microvascular inflammation (PAS+, magnification 40x). (B) Lession scores in ATN, aTCMR and aAMR. Kruskal-Wallis. ***P < 0.0001.
See this image and copyright information in PMC

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