Peritubular capillary basement membrane multilayering in early and advanced transplant glomerulopathy: quantitative parameters and diagnostic aspects

The ultrastructural quantitative aspects of peritubular capillary basement membrane multilayering (PTCBML) were examined in 57 kidney transplant biopsies with transplant glomerulopathy (TG). The measurements included three cutoffs [permissive: 1 PTC with 5 basement membrane (BM) layers, intermediate...

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Published in:Virchows Archiv : an international journal of pathology 2016-11, Vol.469 (5), p.563-573
Main Authors: Dobi, Deján, Bodó, Zsolt, Kemény, Éva, Bidiga, László, Hódi, Zoltán, Szenohradszky, Pál, Szederkényi, Edit, Szilvási, Anikó, Iványi, Béla
Format: Article
Language:English
Subjects:
Basement Membrane - pathology
Biopsy
Capillaries - pathology
Chronic Disease
Complement C4b - metabolism
Female
Graft Rejection - diagnosis
Graft Rejection - pathology
Humans
Kidney Diseases - pathology
Kidney Diseases - therapy
Kidney transplantation
Kidney Transplantation - methods
Male
Medicine
Medicine & Public Health
Original Article
Pathology
Transplantation, Homologous
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Summary:The ultrastructural quantitative aspects of peritubular capillary basement membrane multilayering (PTCBML) were examined in 57 kidney transplant biopsies with transplant glomerulopathy (TG). The measurements included three cutoffs [permissive: 1 PTC with 5 basement membrane (BM) layers, intermediate: 3 PTCs with 5 layers or 1 PTC with 7 layers, strict: 1 PTC with 7 layers and 2 PTCs with 5 layers] and the mean number of BM layers (PTC circ ). Two groups were assigned, namely patients with mild TG (Banff cg1a and cg1b) and those with moderate-to-severe TG (cg2 and cg3). Their respective clinical, serological, and morphological characteristics were then compared. The clinical data revealed that mild TG corresponded to early chronic antibody-mediated rejection (cABMR), while moderate-to-severe TG corresponded to the advanced stage of the disease. The permissive threshold displayed the lowest specificity (73 %) and the highest sensitivity (83 %) for moderate-to-severe TG, and its corresponding PTC circ value was 3 layers. In contrast, the strict threshold—adopted by the Banff 2013 classification—displayed a specificity and sensitivity of 93 and 52 %, respectively, and the corresponding PTC circ was 4 layers. In mild TG, 26 % of the cases met the permissive cutoff and 6 % the strict cutoff. Mild TG was associated with a lower PTC circ (2.6 layers vs 4.5 layers in moderate-to-severe TG; p  
ISSN:0945-6317
1432-2307
DOI:10.1007/s00428-016-2010-1