Risk factors and prognostic significance of microvascular inflammation in the kidney allograft

Introduction: the prognostic significance of microvascular inflammation (MVI) in the absence of donor-specific antibodies (DSA) in kidney allotransplantation (KTx) is not well defined, and the predictors of such immune conflict type remain unclear.
The study was aimed to define the long-term prognosis of MVI and to identify clinical factors associated with MVI.
Material and methods. Two hundred eighty four kidney allograft (KA) recipients were enrolled into the study according to inclusion criteria (AB0-compatibility, negative cytotoxic crossmatch, and at least one KA biopsy in posttransplant period). One hundred fifty patients had MVI. The control group included 134 KTx recipients without MVI. The following clinical parameters were registered: he recipient’s gender and age, donor age, cadaveric/alive donor, cold/warm ischemia time, renal replacement therapy duration, last donor creatinine level, a delayed graft function (DGF), an immunological risk (IR) (number of HLAmm, panel-reactive antibodies, previous KTx), the level of creatinine
and proteinuria at the time of biopsy. The long-term KA survival was estimated by Kaplan–Meier analysis. The combined end-point was determined as the return to dialysis or the estimated glomerular filtration rate 15 mL/min/1,73m2 or less. Multivariate Cox regression analysis was used for the evaluation of independent risk factors associated with the presence of MVI and risk of KA loss.
Results. According to MVI phenotypes, the patients were distributed into the following groups: MVI+DSA+ cases (n=31) that met criteria for antibody-mediated rejection (Banff 2013); MVI+DSA- (n=62); and MVI+DSA? cases (n=57) with undetermined DSA. In MVI+DSA- group, 28 recipients had an isolated MVI, while MVI was accompanied with
T-cell mediated rejection (TCMR) in 34 cases. The median follow-up was 52 (23; 85) months from KTx and 39 (13; 77) months from the biopsy. KA survival in all MVI groups was significantly lower compared with controls. In the adjusted multivariable Cox regression model, MVI was associated with the relative risk of KA loss (Exp(

microvascular rejection, glomerulitis, peritubular capillaritis, immunological risk, antibody-mediated rejection, kidney allograft survival

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