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Kidney Week

Abstract: SA-PO1087

Acute Transient Arteriopathy Mimicking Vascular Rejection in Allograft Kidneys

Session Information

Category: Pathology and Lab Medicine

  • 1502 Pathology and Lab Medicine: Clinical

Authors

  • Riazy, Maziar, University of Washington, Seattle, Washington, United States
  • Minnelli, Carrie R., University of Washington, Seattle, Washington, United States
  • Ohashi, Ryuji, Nipppon Medical School, Tokyo, TOKYO, Japan
  • Kowalewska, Jolanta, Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Leca, Nicolae, University of Washington, Seattle, Washington, United States
  • Najafian, Behzad, University of Washington, Seattle, Washington, United States
  • Nicosia, Roberto F., VA Puget Sound HCS, Seattle, Washington, United States
  • Alpers, Charles E., University of Washington Medical Center, Seattle, Washington, United States
  • Akilesh, Shreeram, University of Washington, Seattle, Washington, United States

Group or Team Name

  • UW renal Pathology
Background

Early dysfunction of renal allografts raises the specter of acute rejection processes that require medical intervention vs. self-limiting peri-operative conditions for which conservative management is indicated. We sought to determine the clinical course in patients who present with delayed graft function and demonstrate a unique pattern of vascular injury that mimics rejection in their biopsy.

Methods

The study population consisted of renal allograft biopsies accessioned at the University of Washington, Seattle, USA from 1/1/2000 to 12/31/2017. We performed a database search of pathology reports for “transplant” and “arteriopathy” within one year following transplantation. Included cases showed a distinct arterial vasculopathy, characterized by endothelial cell swelling, lifting, and intimal edema in the absence of endotheliitis or rejection (Banff IA or higher). We also determined the clinical course of these patients on followup.

Results

We have identified 30 patients with arteriopathy but without rejection in the first year post-transplant. Of these, we have collected follow up on 14 patients to date (remainder in process). These patients (10 male, 4 female) were compliant with their immunosuppression and presented with delayed graft function soon after transplantation (median=13 days, range 7-139). Interlobular-sized arteries were most frequently affected. 11/14 patients received no intervention, while 3/14 received anti-thymocyte globulin (ATG), plasmapheresis or intravenous immunoglobulin (IVIg). 30 days post-transplantation, 11 patients were off dialysis and had a median serum creatinine of 1.85 mg/dL. 90 days after transplantation 13 patients were off dialysis with a median creatinine of 1.67 mg/dL (one patient lost the allograft due to suspected early infarction, indeterminate for vascular rejection).

Conclusion

Acute transient transplant arteriopathy is a rare vascular lesion that is associated with early graft dysfunction in the absence of rejection. Recognition of this lesion and distinguishing it from vascular rejection is important to prevent over-treatment since most patients appear to recover function rapidly without specific interventions.

Funding

  • Clinical Revenue Support