Table 3.
Clinicopathological characteristics of MVI in association with missing self and HLA-DSA (n=222 patients)
| Characteristics | Overall (n=222) | HLA-DSA Negative (n=146) | HLA-DSA Positive (n=76) | P | ||
|---|---|---|---|---|---|---|
| No MS (n=118) | MS (n=28) | No MS (n=63) | MS (n=13) | |||
| Transplantation | ||||||
| Repeat transplantation | 45 (20.3) | 7 (5.9)a,b | 3 (10.7)c | 31 (49.2)a,c | 4 (30.8)b | <0.001 |
| Recipient female sex | 104 (46.8) | 69 (58.5) | 14 (50.0) | 27 (42.9) | 8 (61.5) | 0.21 |
| Recipient age, yr, at transplantation, mean (SD) | 53.2 (14.2) | 53.3 (13.7) | 54.4 (15.0) | 52.6 (14.2) | 52.5 (16.4) | 0.95 |
| Living donation | 9 (4.1) | 5 (4.2) | 1 (3.6) | 3 (4.8) | 0 (0.0) | 0.88 |
| Donor female sex | 105 (47.3) | 61 (51.7) | 13 (46.4) | 37 (58.7) | 6 (46.2) | 0.65 |
| Donor age, yr, mean (SD) | 49.1 (15.3) | 49.7 (13.9) | 52.7 (15.6) | 46.5 (16.2) | 47.7 (20.9) | 0.30 |
| Cold ischemia time, h, mean (SD) | 14.9 (5.5) | 15.0 (5.8) | 14.5 (6.5) | 14.4 (4.8) | 16.4 (2.7) | 0.66 |
| Delayed graft function | 63 (28.4) | 30 (25.4) | 6 (21.4) | 21 (33.3) | 6 (46.2) | 0.27 |
| Biopsy | ||||||
| Days after transplantation, median (IQR) | 91 (7–367) | 92 (7–372) | 92 (11–374) | 90 (7–361) | 17 (7–361) | 0.76 |
| Indication biopsy | 122 (55.0) | 65 (55.1) | 13 (46.4) | 35 (55.6) | 9 (69.2) | 0.59 |
| eGFR, ml/min per 0.73 m2, mean (SD) | 33.5 (22.1) | 33.8 (23.0) | 35.6 (20.6) | 33.3 (21.9) | 27.4 (18.5) | 0.74 |
| Proteinuria, g/g creatinine, median (IQR) | 0.3 (0.1–0.6) | 0.3 (0.1–0.6) | 0.2 (0.1–0.3) | 0.3 (0.1–0.9) | 0.6 (0.3–0.7) | 0.12 |
| Preceding CMV disease | 21 (9.5) | 16 (13.6)a | 3 (10.7) | 1 (1.6)a | 1 (7.7) | 0.08 |
| Treatment after biopsy | 110 (49.5) | 58 (49.2) | 12 (42.9) | 32 (50.8) | 8 (61.5) | 0.73 |
| Steroid monotherapy | 90 (40.5) | 49 (41.5) | 11 (39.3) | 25 (39.7) | 5 (38.5) | |
| Othere | 20 (9.0) | 9(7.6) | 1 (3.6) | 7 (11.1) | 3 (23.1) | |
| Histology | ||||||
| Glomerulitis | 149 (67.2) | 73 (61.9) | 18 (64.3) | 48 (76.2) | 10 (76.9) | 0.21 |
| Peritubular capillaritis | 167 (75.3) | 88 (74.6) | 20 (71.4) | 48 (76.2) | 11 (84.6) | 0.83 |
| Intimal arteritis | 70 (31.5) | 36 (30.5) | 9 (32.1) | 21 (33.3) | 4(30.8) | 0.98 |
| C4d deposition in peritubular capillaries | 77 (34.7) | 30 (25.4)a,b | 8(28.6) | 31 (49.2)a | 8 (61.5)b | 0.002 |
| Transplant glomerulopathy | 12 (5.4) | 6 (5.1) | 0 (0.0) | 6 (9.5) | 0(0.0) | 0.22 |
| Thrombotic microangiopathy | 11 (5.1) | 5 (4.3) | 3 (10.3) | 2 (3.8) | 1 (5.9) | 0.48 |
| Tubulitis | 148 (66.6) | 86 (72.9) | 18 (64.3) | 35 (55.6) | 9 (69.2) | 0.13 |
| Interstitial inflammation | 117 (52.7) | 68 (57.6) | 14 (50.0) | 26 (41.3) | 9 (69.2) | 0.11 |
| Arteriolar hyalinosis | 75 (33.8) | 37 (31.4) | 12 (42.9) | 24 (38.1) | 2 (15.4) | 0.28 |
| Interstitial fibrosis | 66 (29.7) | 37 (31.4) | 9 (32.1) | 18 (28.6) | 2 (15.4) | 0.67 |
| Tubular atrophy | 137 (61.7) | 75 (63.6) | 20 (71.4) | 34 (54.0) | 8 (61.5) | 0.41 |
| Arterial fibrointimal thickening | 111 (50.0) | 56 (47.5) | 16 (57.1) | 34 (54.0) | 5 (38.5) | 0.58 |
| Borderline changes | 32 (14.4) | 19 (16.1) | 6 (21.4) | 5 (7.9) | 2 (15.4) | 0.32 |
| T cell-mediated rejection | 93 (41.9) | 55 (46.6) | 9 (32.1) | 22 (34.9) | 7 (53.9) | 0.24 |
| Repeat MVI on next biopsyf | 64 (31.7) | 25 (23.2)a,b | 3 (12.0)c,d | 27 (47.4)a,c | 9 (75.0)b,d | <0.001 |
| Development of cg>0 after the first MVI biopsyg | 31 (14.9) | 10 (9.0)b | 4 (14.3) | 12 (21.1) | 5 (41.7)b | 0.01 |
Data are derived from the first biopsies with MVI during post-transplant histologic follow-up (n=222 transplants). Values are n (%) unless otherwise specified. Individual histologic lesions were considered as absent (Banff score of 0) or present (Banff score of 1, 2 or 3). P values for differences between all groups are given. MS, high missing self (1–2 types); IQR, interquartile range; cg, transplant glomerulopathy.
Significant pairwise comparisons between groups.
Varying combinations of plasmapheresis, anti-thymocyte globulin, rituximab, bortezomib and intravenous Igs.
Only patients with histologic follow-up included.
Only patients without transplant glomerulopathy and with histologic follow-up included.