Re‐evaluation of glomerulitis using occlusion criteria based on the Banff 2013 revision: a retrospective study. (24th March 2017)

• Record Type: Journal Article
• Authors: Ozluk, Yasemin; Caliskan, Yasar; Sevinc, Mustafa; Bayram, Aysel; Arikan, Evsen A.; Turkmen, Aydin; Akgul, Sebahat; Savran, Fatma O.; Sever, Mehmet S.; Kilicaslan, Isin
• Is Part Of: Transplant international. Volume 30:Number 6(2017)
• Page Start: 579
• Page End: 588
• Publication Date: 2017-03-24
• Subjects: Banff classification -- biopsy -- glomerulitis -- renal transplant; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.12943
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: 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.