Re-Evaluating the Transplant Glomerulopathy Lesion-Beyond Donor-Specific Antibodies

Overview

Journal Transpl Int

Specialty General Surgery

Date 2024 Dec 6

PMID 39640250

Authors

Arun Chutani

Daniel Guevara-Pineda

Gabriel B Lerner

Madhav C Menon

Affiliations

Soon will be listed here.

Abstract

There have been significant advances in short-term outcomes in renal transplantation. However, longer-term graft survival has improved only minimally. After the first post-transplant year, it has been estimated that chronic allograft damage is responsible for 5% of graft loss per year. Transplant glomerulopathy (TG), a unique morphologic lesion, is reported to accompany progressive chronic allograft dysfunction in many cases. While not constituting a specific etiologic diagnosis, TG is primarily considered as a histologic manifestation of ongoing allo-immune damage from donor-specific anti-HLA alloantibodies (DSA). In this review article, we re-evaluate the existing literature on TG, with particular emphasis on the role of non-HLA-antibodies and complement-mediated injury, cell-mediated immune mechanisms, and early podocyte stress in the pathogenesis of Transplant Glomerulopathy.

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