Microvascular inflammation in renal allograft biopsies assessed by endothelial and leukocyte co-immunostain: a retrospective study on reproducibility and clinical/prognostic correlates

Marco Delsante, Umberto Maggiore, Jonathan Levi, David E. Kleiner, Annette M. Jackson, Lois J. Arend, Stephen M. Hewitt, Naima Carter-Monroe, Serena M. Bagnasco, Avi Z. Rosenberg

Research output: Contribution to journalArticlepeer-review

Abstract

The most prominent histologic lesion in antibody-mediated rejection is microvascular inflammation (MVI); however, its recognition and scoring can be challenging and poorly reproducible between pathologists. We developed a dual immunohistochemical (IHC)-stain (anti-CD34/anti-CD45 for endothelium/leukocytes) as ancillary tool to improve on the semi-quantitative Banff scores and allow quantification of MVI. We examined the relationship between CD34–CD45 IHC-based quantitative MVI score (the inflamed peritubular capillary ratio, iptcr) and renal-graft failure or donor-specific antibodies (DSA) strength at the time of biopsy. Quantitative iptcr score was significantly associated with renal graft failure (hazard ratio 1.81, per 1 SD-unit [0.13 points] of iptcr-increase; P = 0.026) and predicted the presence and strength of DSA (ordinal odds ratio: 2.42; P = 0.005; 75 biopsies/60 kidney transplant recipients; 30 HLA- and/or ABO-incompatible). Next, we assessed inter-pathologist agreement for ptc score and ptc extent (focal/diffuse) using CD34–CD45 IHC as compared to conventional stain. Compared to conventional stain, CD34–CD45 IHC significantly increased inter-pathologist agreement on ptc score severity and extent (κ-coefficient from 0.52–0.80 and 0.46–0.68, respectively, P < 0.001). Our findings show that CD34–CD45 IHC improves reproducibility of MVI scoring and facilitates MVI quantification and introduction of a dual anti-CD34/CD45 has the potential to improve recognition of MVI ahead of DSA results.

Original languageEnglish (US)
Pages (from-to)300-312
Number of pages13
JournalTransplant International
Volume32
Issue number3
DOIs
StatePublished - Mar 2019

Keywords

  • kidney clinical
  • rejection

ASJC Scopus subject areas

  • Transplantation

Fingerprint Dive into the research topics of 'Microvascular inflammation in renal allograft biopsies assessed by endothelial and leukocyte co-immunostain: a retrospective study on reproducibility and clinical/prognostic correlates'. Together they form a unique fingerprint.

Cite this