Abstract:

Objective: To investigate the clinicopathological features of transplant glomerulopathy (TG). Methodology: TG was diagnosed in 79 (12.7%) of 622 patients followed in our kidney transplant center during t January 2004 and July 2011 in Jinling Hospital, and their clinical and concurrent pathological features were investigated retrospectively. Results: The onset of TG was 81.0 ±45.0 months after transplantation. According to Banff 2007 classi?cation, 42 were severe TG (cg3), 30 were moderate (cg2), and 7 case was mild (cg1). The prior acute antibody-mediated rejection was in 28 cases (35.4%), proteinuria (1.70±1.48 g/day) in 72 (91.1%), anemia (hemoglobin 11.02±9.29g/dl) in 67 (84.8%) and declining graft function (Scr 228.07 ± 127umol/L) was in 70 cases (88.6%). Compared with cg1 and cg2 group, the cg3 group had a higher incidence and severity of proteinuria (P<0.01), and a lower level of plasma-albumin (P<0.05). By flow PRA, anti-HLA antibody was detected in 35/65 (53.9%) with available sera, either against class II HLA (n= 30, 46.2%) or class I HLA (n=9, 13.9%) or both (n=4). The histopathological changes of TG was characterized by double contours of glomerular basement membranes (GBM), transplant glomerulitis, peritubular capillaritis, interstitial ?brosis (IF) and tubular atrophy (TA). C4d deposition in peritubular capillary (PTC) by indirect immunofluorescence was presented in 44/79 (55.7%). Compared with cg1 and cg2 group, the cg3 group had much severe glomerulitis and macrophage infiltration, but there were no significant differences in other histopathological changes including IF/TA between the three groups. Conclusion: TG was characterized by proteinuria and declining graft function in our patients; 84.8% had anemia and 35.4% had the history of acute rejection, and PRA level may be associated with TG, too. The histopathological changes of TG is characterized by double contours of GBM, transplant glomerulitis, peritubular capillaritis, interstitial ?brosis (IF) and tubular atrophy (TA) that maybe associate with chronic antibody mediated rejection.