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. 2025 Jun 18.
doi: 10.1007/s40620-025-02308-3. Online ahead of print.

Kidney transplant arteriopathy revisited

Katharina Wirths  1   2 , Michael Thomas  3 , Georg Dieplinger  3 , Tristan Wagner  3 , Wolfgang Arns  4 , Hans Schlösser  3 , Rabi Raj Datta  3 , Francesco Pesce  5 , Vanessa Ditt  4 , Ulrich Lang  4 , Michael Ströhlein  6 , Ulrike Bauernfeind  4 , Christine Kurschat  7 , Lutz Thorsten Weber  8 , Dirk Stippel  3 , Jan U Becker  9
Affiliations

Kidney transplant arteriopathy revisited

Katharina Wirths et al. J Nephrol. .

Abstract

Background: Transplant 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.

Methods: We 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.

Results: Transplant 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.

Conclusions: The 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.

Keywords: Antibody-mediated rejection; Nephropathology; Rejection; Renal biopsy; Transplant vasculopathy.

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Conflict of interest statement

Declarations. Conflict of interest: JUB is consultant for Sanofi and Novartis. The other authors have nothing to declare. Ethical approval: This study was approved by the Institutional Review Board (11–116) of the University Hospital of Cologne. All transplantations were conducted following the declaration of Istanbul [38]. Informed consent to participate: Patient consent was obtained according to the permission obtained from the Ethical Review Board.

References

    1. Hume DM, Merrill JP, Miller BF et al (1955) Experiences with renal homotransplantation in the human: report of nine cases. J Clin Invest 34(2):327–382 - DOI - PubMed - PMC
    1. Dempster WJ (1953) A toxic syndrome observed in dogs with transplanted kidneys. Acta Med Scand 144(5):361–370 - DOI - PubMed
    1. Porter KA, Thomson WB, Owen K et al (1963) Obliterative Vascular Changes in Four Human Kidney Homotransplants. Br Med J 2(5358):639–645 - DOI - PubMed - PMC
    1. Hammond EH, Yowell RL, Price GD et al (1992) Vascular rejection and its relationship to allograft coronary artery disease. J Heart Lung Transplant 11(3 Pt 2):S111-119 - PubMed
    1. Muller-Hermelink HK, Dammrich JR (1989) Obliterative transplant vasculopathy: pathogenesis and pathologic mechanisms. Verh Dtsch Ges Pathol 73:193–206 - PubMed

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