Bowman capsulitis predicts poor kidney allograft outcome in T cell–mediated rejection

Acute T cell–mediated rejection (TCMR) is an important cause of renal allograft loss. The Banff classification for tubulointerstitial (type I) rejection is based on the extent of both interstitial inflammation and tubulitis. Lymphocytes may also be present between parietal epithelial cells and Bowma...

Full description

Saved in:
Bibliographic Details
Published in:Human pathology 2018-06, Vol.76, p.47-51
Main Authors: Gallan, Alexander J., Chon, Woojin James, Josephson, Michelle A., Cunningham, Patrick N., Henriksen, Kammi J., Chang, Anthony
Format: Article
Language:English
Subjects:
African Americans
Age
Allograft outcomes
Antigens
Banff classification
Biopsy
Bowman capsule
Capsulitis
Cytokines
Demographics
Ethnicity
Hemodialysis
Immunoglobulins
Inflammation
Kidney biopsy
Lymphocytes
Patients
Studies
T cell–mediated rejection
Transplants & implants
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Acute T cell–mediated rejection (TCMR) is an important cause of renal allograft loss. The Banff classification for tubulointerstitial (type I) rejection is based on the extent of both interstitial inflammation and tubulitis. Lymphocytes may also be present between parietal epithelial cells and Bowman capsules in this setting, which we have termed “capsulitis.” We conducted this study to determine the clinical significance of capsulitis. We identified 42 patients from the pathology archives at The University of Chicago with isolated Banff type I TCMR from 2010 to 2015. Patient demographic data, Banff classification, and graft outcome measurements were compared between capsulitis and noncapsulitis groups using Mann-Whitney U test. Capsulitis was present in 26 (62%) and was more frequently seen in Banff IB than in IA TCMR (88% versus 44%, P = .01). Patients with capsulitis had a higher serum creatinine at biopsy (4.6 versus 2.9 mg/dL, P = .04) and were more likely to progress to dialysis (42% versus 13%, P = .06), with fewer recovering their baseline serum creatinine (12% versus 38%, P = .08). Patients with both Banff IA TCMR and capsulitis have clinical outcomes similar to or possibly worse than Banff IB TCMR compared with those with Banff IA and an absence of capsulitis. Capsulitis is an important pathologic parameter in the evaluation of kidney transplant biopsies with potential diagnostic, prognostic, and therapeutic implications in the setting of TCMR. •Capsulitis may be observed in TCMR of the kidney.•Capsulitis occurs more frequently in Banff IB than in IA TCMR.•Patients with capsulitis have worse graft outcomes.
ISSN:0046-8177
1532-8392
DOI:10.1016/j.humpath.2018.02.016