Re-evaluation of glomerulitis using occlusion criteria based on the Banff 2013 revision: a retrospective study

• DOI: 10.1111/tri.12943
• Publication Date: 2017-02-25T20:46:49Z
• Authors: Yasemin Ozluk; Yasar Caliskan; Mustafa Sevinc; Aysel Bayram; Evsen A. Arikan; Aydin Turkmen; Sebahat Akgul; Fatma O. Savran; Mehmet S. Sever; Isin Kilicaslan
• Keywords: Adult; Male; Observer Variation; Adolescent; Biopsy; Graft Survival; Kidney Glomerulus; Graft Occlusion, Vascular; Middle Aged; Kidney Transplantation; Tissue Donors; Capillaries; 3. Good health; Young Adult; 03 medical and health sciences; Glomerulonephritis; 0302 clinical medicine; Antibody Specificity; Isoantibodies; Humans; Female; Aged; Retrospective Studies

The presence of occlusion/near-occlusion of glomerular capillaries was recently added to the existing definition of glomerulitis (g). We retrospectively re-evaluated 135 renal allograft biopsies regarding g to ensure no antibody-damaged grafts were missed. Previous and revised g scores (pg and rg, respectively) were compared for clinicopathologic correlations. The g score did not change in 100 (74.1%) biopsies. Thirty-five (25.9%) biopsies were changed to a lower score. Sensitivity and specificity of pg and rg for the presence of donor-specific antibodies (DSA) were 76% vs. 58% and 70% vs. 79%, respectively. Pg score indicated graft loss with 65% sensitivity and 63% specificity, whereas rg showed 46% sensitivity and 71% specificity. Area under the curve (AUC) values in ROC analysis for DSA and graft loss were as follows: pg, 0.773; rg, 0.693; and pg, 0.635; rg, 0.577, respectively. A comparison of the two AUC values revealed a significant difference between pg and rg only for DSA (P = 0.0076). Pg and post-transplant time of biopsy independently predicted graft loss, whereas rg did not. In conclusion, revised g scores showed lesser sensitivity but higher specificity for DSA and graft loss. Recent definition of g missed antibody-mediated rejection in few cases, and it was not an independent predictor for graft loss.