Overlapping pathways to transplant glomerulopathy: Chronic humoral rejection, hepatitis C infection, and thrombotic microangiopathy

Seema Baid-Agrawal, Alton B. Farris, Manuel Pascual, Shamila Mauiyyedi, Mary Lin Farrell, Nina Tolkoff-Rubin, A. Bernard Collins, Ulrich Frei, Robert B. Colvin

Research output: Contribution to journalArticlepeer-review

121 Scopus citations

Abstract

Transplant glomerulopathy (TG) has received much attention in recent years as a symptom of chronic humoral rejection; however, many cases lack C4d deposition and/or circulating donor-specific antibodies (DSAs). To determine the contribution of other causes, we studied 209 consecutive renal allograft indication biopsies for chronic allograft dysfunction, of which 25 met the pathological criteria of TG. Three partially overlapping etiologies accounted for 21 (84%) cases: C4d-positive (48%), hepatitis C-positive (36%), and thrombotic microangiopathy (TMA)-positive (32%) TG. The majority of patients with confirmed TMA were also hepatitis C positive, and the majority of hepatitis C-positive patients had TMA. DSAs were significantly associated with C4d-positive but not with hepatitis C-positive TG. The prevalence of hepatitis C was significantly higher in the TG group than in 29 control patients. Within the TG cohort, those who were hepatitis C-positive developed allograft failure significantly earlier than hepatitis C-negative patients. Thus, TG is not a specific diagnosis but a pattern of pathological injury involving three major overlapping pathways. It is important to distinguish these mechanisms, as they may have different prognostic and therapeutic implications.

Original languageEnglish (US)
Pages (from-to)879-885
Number of pages7
JournalKidney International
Volume80
Issue number8
DOIs
StatePublished - Oct 2 2011
Externally publishedYes

Keywords

  • antibody-mediated rejection
  • hepatitis
  • kidney transplantation

ASJC Scopus subject areas

  • Nephrology

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