Post-Transplant Glomerulonephritis Has a Molecular Behavior of Antibody Mediated Rejection.

Abstract

Post-transplant glomerulonephritis (GN) is a common cause of kidney transplant failure. We studied conventional and molecular features in 69 biopsies diagnosed as GN from 62 patients, identified in prospective studies of 703 unselected indication biopsies from 562 kidney transplants. We grouped these biopsies as 19 IgAN, seven FSGS, four MGN, seven MPGN, 10 proliferative GN, and 22 that were not considered classifiable by the pathologist. Using the microarray-based molecular microscope system, we studied transcript sets and molecular scores, particularly the Acute Kidney Injury (AKI) Score and the Antibody-Mediated Rejection (ABMR) Score. GN biopsies had molecular abnormalities, generally intermediate between ABMR and normal transplants, and were not related to the GN type. In biopsies with GN, the AKI and ABMR Scores in multivariable analysis were independent predictors of failure, and both correlated with histologic scarring and reduced GFR. High ABMR Scores in GN also correlated with cg and g lesions. Positive ABMR Scores in some biopsies with a histologic diagnosis of GN could reflect two diseases (ABMR plus GN), ABMR-like mechanisms in some GN, or mistaken diagnosis of GN in ABMR. GN biopsies with high ABMR score had a worse graft survival than the others.Figure: No Caption available.The strong association of molecular scores such as the AKI Score with outcomes in post transplant GN provides new prognostic insight, and suggests potential for application of molecular methods in primary GN. DISCLOSURE:Halloran, P.: Speaker’s Bureau, Astellas, Novartis, OneLamba.