Journal Article
. 2008 Feb; 8(4):819-25.
doi: 10.1111/j.1600-6143.2007.02137.x.

Peritubular capillaritis in renal allografts: prevalence, scoring system, reproducibility and clinicopathological correlates

I W Gibson 1 W Gwinner  V Bröcker  B Sis  J Riopel  I S D Roberts  I Scheffner  G S Jhangri  M Mengel  
  • PMID: 18261174
  •     24 citations


While glomerulitis is graded according to the Banff classification, no criteria for scoring peritubular capillaritis (PTC) have been established. We retrospectively applied PTC-scoring criteria to 688 renal allograft (46 preimplantation, 461 protocol, 181 indication) biopsies. A total of 26.3% of all analyzed biopsies had peritubular capillaritis (implant 0%, protocol 17.6%, indication 45.5%; p < 0.0001). The most common capillaritis pattern was of moderate severity (5-10 luminal cells), focal in extent (10-50% of PTC), with a minority of neutrophils. A total of 24% of C4d- compared with 75% of C4d+ biopsies showed capillaritis (p < 0.0001). More than 80% of biopsies with glomerulitis had peritubular capillaritis. A total of 50.4% of biopsies with borderline or T-cell mediated rejection (TCMR) and 14.1% of biopsies without TCMR or antibody-mediated rejection (ABMR) showed capillaritis (p < 0.0001). The inter-observer reproducibility of the PTC-scoring features was fair to moderate. Diffuse capillaritis detected in early protocol biopsies had significant negative prognostic impact in terms of glomerular filtration rate 2 years posttransplantation. Indication biopsies show a significantly higher prevalence of capillaritis than protocol biopsies (45.5% vs. 17.6%; p < 0.0001). Capillaritis is more frequent and pronounced in ABMR, but can be observed in TCMR cases. Thus, scoring of peritubular capillaritis is feasible and can provide prognostic and diagnostic information in renal allograft biopsies.

Focal C4d+ in renal allografts is associated with the presence of donor-specific antibodies and decreased allograft survival.
R L Kedainis, M J Koch, D C Brennan, H Liapis.
Am J Transplant, 2009 Apr 07; 9(4). PMID: 19344468    Free PMC article.
Optimal cutoff point for immunoperoxidase detection of C4d in the renal allograft: results from a multicenter study.
Gretchen S Crary, Yassaman Raissian, +5 authors, Joseph P Grande.
Transplantation, 2011 Mar 25; 90(10). PMID: 21430605    Free PMC article.
Chronic progressive calcineurin nephrotoxicity: an overstated concept.
Arthur J Matas.
Am J Transplant, 2011 Mar 31; 11(4). PMID: 21446973    Free PMC article.
Digital pathology evaluation of complement C4d component deposition in the kidney allograft biopsies is a useful tool to improve reproducibility of the scoring.
Ernesta Brazdziute, Arvydas Laurinavicius.
Diagn Pathol, 2011 Apr 22; 6 Suppl 1. PMID: 21489200    Free PMC article.
Diagnostic challenges in chronic antibody-mediated rejection.
Evan A Farkash, Robert B Colvin.
Nat Rev Nephrol, 2012 Mar 28; 8(5). PMID: 22450441    Free PMC article.
Enhanced de novo alloantibody and antibody-mediated injury in rhesus macaques.
E K Page, A J Page, +8 authors, S J Knechtle.
Am J Transplant, 2012 Jul 11; 12(9). PMID: 22776408    Free PMC article.
Diagnostic significance of peritubular capillary basement membrane multilaminations in kidney allografts: old concepts revisited.
George Liapis, Harsharan K Singh, +3 authors, Volker Nickeleit.
Transplantation, 2012 Sep 01; 94(6). PMID: 22936037    Free PMC article.
Partial therapeutic response to Rituximab for the treatment of chronic alloantibody mediated rejection of kidney allografts.
R Neal Smith, Fahim Malik, +6 authors, Waichi Wong.
Transpl Immunol, 2012 Sep 11; 27(2-3). PMID: 22960786    Free PMC article.
Pathological diagnosis of antibody-mediated rejection in renal allograft without c4d staining, how much reliable?
Diana Taheri, Ardeshir Talebi, +6 authors, Mohsen Nasr.
Adv Biomed Res, 2013 Jan 18; 1. PMID: 23326771    Free PMC article.
The clinical and genomic significance of donor-specific antibody-positive/C4d-negative and donor-specific antibody-negative/C4d-negative transplant glomerulopathy.
Nicole Hayde, Yi Bao, +8 authors, Enver Akalin.
Clin J Am Soc Nephrol, 2013 Sep 14; 8(12). PMID: 24030736    Free PMC article.
The specificity of acute and chronic microvascular alterations in renal allografts.
Edward J Filippone, John L Farber.
Clin Transplant, 2013 Oct 15; 27(6). PMID: 24118527    Free PMC article.
Biomarkers for kidney transplant rejection.
Denise J Lo, Bruce Kaplan, Allan D Kirk.
Nat Rev Nephrol, 2014 Jan 22; 10(4). PMID: 24445740
Capillary dilation and rarefaction are correlated with intracapillary inflammation in antibody-mediated rejection.
Xue Li, Qiquan Sun, +3 authors, Zhihong Liu.
J Immunol Res, 2014 Apr 18; 2014. PMID: 24741607    Free PMC article.
The diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk factor for graft loss.
Nicolas Kozakowski, Harald Herkner, +4 authors, Željko Kikić.
Kidney Int, 2015 Mar 05; 88(2). PMID: 25738252
Peritubular capillaritis in the renal allograft takes center stage.
Lorraine C Racusen, Serena M Bagnasco.
Kidney Int, 2015 Aug 01; 88(2). PMID: 26230198
Current pathological perspectives on chronic rejection in renal allografts.
Shigeo Hara.
Clin Exp Nephrol, 2016 Nov 17; 21(6). PMID: 27848058
Safety and efficacy of eculizumab in the prevention of antibody-mediated rejection in living-donor kidney transplant recipients requiring desensitization therapy: A randomized trial.
William H Marks, Nizam Mamode, +9 authors, C10-001 Study Group.
Am J Transplant, 2019 Mar 20; 19(10). PMID: 30887675    Free PMC article.
A Fully Automated System Using A Convolutional Neural Network to Predict Renal Allograft Rejection: Extra-validation with Giga-pixel Immunostained Slides.
Young-Gon Kim, Gyuheon Choi, +5 authors, Namkug Kim.
Sci Rep, 2019 Mar 28; 9(1). PMID: 30914690    Free PMC article.
Banff survey on antibody-mediated rejection clinical practices in kidney transplantation: Diagnostic misinterpretation has potential therapeutic implications.
Carrie A Schinstock, Ruth Sapir-Pichhadze, +15 authors, Edward Kraus.
Am J Transplant, 2018 Jun 24; 19(1). PMID: 29935060    Free PMC article.
A method to reduce variability in scoring antibody-mediated rejection in renal allografts: implications for clinical trials - a retrospective study.
Byron Smith, Lynn D Cornell, +9 authors, Mark Stegall.
Transpl Int, 2018 Sep 05; 32(2). PMID: 30179275    Free PMC article.
A Peripheral Blood Gene Expression Signature to Diagnose Subclinical Acute Rejection.
Weijia Zhang, Zhengzi Yi, +25 authors, Barbara Murphy.
J Am Soc Nephrol, 2019 Jul 07; 30(8). PMID: 31278196    Free PMC article.
Pre-Transplant Angiotensin II Type 1 Receptor Antibodies and Anti-Endothelial Cell Antibodies Predict Graft Function and Allograft Rejection in a Low-Risk Kidney Transplantation Setting.
Shinae Yu, Hee Jae Huh, +7 authors, Eun-Suk Kang.
Ann Lab Med, 2020 Apr 21; 40(5). PMID: 32311853    Free PMC article.
Microvascular inflammation in renal allograft biopsies assessed by endothelial and leukocyte co-immunostain: a retrospective study on reproducibility and clinical/prognostic correlates.
Marco Delsante, Umberto Maggiore, +7 authors, Avi Z Rosenberg.
Transpl Int, 2018 Nov 06; 32(3). PMID: 30395360    Free PMC article.
Integrative Analyses of Circulating Small RNAs and Kidney Graft Transcriptome in Transplant Glomerulopathy.
Canan Kuscu, Manjari Kiran, +9 authors, Enver Akalin.
Int J Mol Sci, 2021 Jul 03; 22(12). PMID: 34207555    Free PMC article.