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ORIGINAL RESEARCH
Transpl Int
Volume 37 - 2024 |
doi: 10.3389/ti.2024.13464
This article is part of the Special Issue Anti-HLA DSA and Beyond: deciphering the immunological mechanisms driving chronic rejection View all 12 articles
Expanding the Scope of Microvascular Inflammation: Unveiling its Presence Beyond Antibody-Mediated Rejection into T-Cell Mediated Contexts
Hilal Varol
1*
Anne Wagenmakers
1
Konrad Hoeft
2
Jasper Callemeyn
3,4
Roos Bodewes
1
Wichor Bramer
5
Andrew Stubbs
1
Rafael Kramann
2,6
Maarten Naesens
3,4
Marian C. Clahsen-van Groningen
1,2*- 1 Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, Netherlands
- 2 Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany
- 3 Department of Nephrology, University Hospitals Leuven, Leuven, Brussels, Belgium
- 4 Department of Microbiology, Immunology and Transplantation, Faculty of Medicine, KU Leuven, Leuven, Belgium
- 5 Erasmus Medical Center, Rotterdam, Netherlands
- 6 Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
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 cellmediated 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: kideny transplantation, Banff classification, MVI, histology, TCMR
Received: 29 Jun 2024; Accepted: 13 Dec 2024.
Copyright: © 2024 Varol, Wagenmakers, Hoeft, Callemeyn, Bodewes, Bramer, Stubbs, Kramann, Naesens and Clahsen-van Groningen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hilal Varol, Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, Netherlands
Marian C. Clahsen-van Groningen, Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, Netherlands
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