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Virchows Archiv

, Volume 469, Issue 5, pp 563–573 | Cite as

Peritubular capillary basement membrane multilayering in early and advanced transplant glomerulopathy: quantitative parameters and diagnostic aspects

  • Deján DobiEmail author
  • Zsolt Bodó
  • Éva Kemény
  • László Bidiga
  • Zoltán Hódi
  • Pál Szenohradszky
  • Edit Szederkényi
  • Anikó Szilvási
  • Béla Iványi
Original Article

Abstract

The ultrastructural quantitative aspects of peritubular capillary basement membrane multilayering (PTCBML) were examined in 57 kidney transplant biopsies with transplant glomerulopathy (TG). The measurements included three cutoffs [permissive: 1 PTC with 5 basement membrane (BM) layers, intermediate: 3 PTCs with 5 layers or 1 PTC with 7 layers, strict: 1 PTC with 7 layers and 2 PTCs with 5 layers] and the mean number of BM layers (PTCcirc). Two groups were assigned, namely patients with mild TG (Banff cg1a and cg1b) and those with moderate-to-severe TG (cg2 and cg3). Their respective clinical, serological, and morphological characteristics were then compared. The clinical data revealed that mild TG corresponded to early chronic antibody-mediated rejection (cABMR), while moderate-to-severe TG corresponded to the advanced stage of the disease. The permissive threshold displayed the lowest specificity (73 %) and the highest sensitivity (83 %) for moderate-to-severe TG, and its corresponding PTCcirc value was 3 layers. In contrast, the strict threshold—adopted by the Banff 2013 classification—displayed a specificity and sensitivity of 93 and 52 %, respectively, and the corresponding PTCcirc was 4 layers. In mild TG, 26 % of the cases met the permissive cutoff and 6 % the strict cutoff. Mild TG was associated with a lower PTCcirc (2.6 layers vs 4.5 layers in moderate-to-severe TG; p < 0.0001). Amongst the various criteria, the permissive criterion was associated most frequently with mild TG, and had prognostic relevance. Because of this, we propose its usage as a marker of early cABMR-induced PTCBML if non-alloimmune causes of PTCBML can be ruled out.

Keywords

Renal transplantation Chronic antibody-mediated rejection Peritubular capillaries 

Notes

Compliance with ethical standards

Funding

The authors declare that they did not have grant funding for the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

This was a retrospective cohort study on human kidney biopsy material taken primarily for diagnostic purposes. During the research process authors reviewed the biopsy material.

Informed consent

All patients gave their informed consent before the biopsy procedure.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Deján Dobi
    • 1
    Email author
  • Zsolt Bodó
    • 1
  • Éva Kemény
    • 1
  • László Bidiga
    • 2
  • Zoltán Hódi
    • 3
  • Pál Szenohradszky
    • 3
  • Edit Szederkényi
    • 3
  • Anikó Szilvási
    • 4
  • Béla Iványi
    • 1
  1. 1.Department of Pathology, Faculty of MedicineUniversity of SzegedSzegedHungary
  2. 2.Department of Pathology, Faculty of MedicineUniversity of DebrecenDebrecenHungary
  3. 3.Department of Surgery, Faculty of MedicineUniversity of SzegedSzegedHungary
  4. 4.Transplantation Immunogenetics LaboratoryHungarian National Blood Transfusion ServiceBudapestHungary

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