Clinicopathological Features Of Transplant Glomerulopathy

Objective: To investigated the clinicopathological features of transplant glomerulopathy.Methodology:We retrospectively examined79TG cases between January2004and July2011in Jinling Hospital on the clinical and concurrent pathological features.Results:Of622patients followed in our kidney transplant center during this period, TG was diagnosed in79cases (12.70%). The onset of TG was81±45months after transplantation. Among79cases of TG,42cases were severe TG (cg3in Banff2007classification),30cases were moderate (cg2), and7case was mild (cgl).28/79(35.44%) had prior acute antibody-mediated rejection,72/79(91.1%) had proteinuria (1.70±1.48g/day),67/79(84.81%) presented with anemia (hemoglobin11.02±9.29g/dl) and70/79(88.61%) with declining graft function (serum creatinine2.58±1.44mg/dl). Compared with cgl and cg2group, the cg3group got a higher incidence and severity of proteinuria (P<0.01), a lower level of plasma-albumin (P<0.05). By flow PRA, Anti-HLA antibody was detected in35/65(53.85%) with available sera, either against class II HLA (n=30,46.15%) or class I HLA (n=9,13.85%) or both (n=4). The histopathological changes of TG is characterized by double contours of glomerular basement membranes (GBM), transplant glomerulitis, peritubular capillaritis, interstitial fibrosis (IF) and tubular atrophy (TA). C4d deposition in peritubular capillary (PTC) by indirect immunofluorescence was presented in44/79(55.70%). Compared with cg1and cg2group, the cg3group got a higher severity of glomerulitis and higher count of macrophage, but there are no significant differences in other histopathological changes including IF/TA between the three groups.Conclusions:TG is characterized by proteinuria and declining graft function,84.81%presented with anemia and35.44%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 glomerular basement membranes (GBM), transplant glomerulitis, peritubular capillaritis, interstitial fibrosis (IF) and tubular atrophy (TA) that maybe associate with chronic antibody mediated rejection.