THE IMPORTANCE OF GLOMERULAR VON WILLEBRAND FACTOR IN HUMAN RENAL ALLOGRAFTS

 

Ozdemir BH, Demirhan B, Haberal M*

Departments of Pathology and General Surgery*, Baskent University, Faculty of Medicine

Ankara-Turkey

 

The aim of this study was to evaluate the role and prognostic importance of glomerular endothelial cell alteration in human renal allografts with deteriorated function following transplantation.

We examined 72 patients with renal transplantation among whom 40 were in acute rejection (AR) and 32 in chronic rejection (CR). All biopsies were immunostained with monoclonal antibodies specific for Yon Willebrand factor (vWF), fibronectin (FN) and CD68. Glomerular staining for vWF and FN was graded in a semiquantitative manner using the 1-3+ scale. All follow-up biopsies of patients with AR were re-evaluated for the presence of interstitial fibrosis and transplant glomerulopathy.

In the CR group there was markedly increased expression of vWF and FN in the glomeruli, whereas only 8 of 40 AR cases showed intense (grade 3) glomerular vWF. All of the 8 patients with intense glomerular vWF were showed type II vascular rejection. A significant difference was found between patients with AR and CR in regards of glomerular vWF deposition (p<0.01). A positive correlation between the degree of glomerular vWF deposition and early interstitial fibrosis was found in cases with AR in follow-up biopsies (p<0.05). The presence of transplant glomerulopathy significantly found earlier in cases with intense glomerular vWF deposition in AR group (p<0.01). We found strong correlation between both intraglomerular FN expression and macrophage infiltration with the degree of glomerular vWF deposition both in AR and CR group (p<0.05). The outcome for grafts that showed intense (grade 3) glomerular vWF was significantly worse than the outcome noted for other grafts with grade 1 and 2 glomerular vWF during the follow-up (p<0.001).

Increased glomerular vWF deposition in cases with AR is in risk of early transplant glomerulopathy, early interstitial fibrosis and early graft loss. In addition intense glomerular vWF deposition was observed in almost all biopsies of cases with CR. In conclusion it may be beneficial to use new therapeutic approaches such as anticoagulant medicine for the treatment of AR and CR in future.

 

 

 

THE IMPORTANCE OF GLOMERULAR VON WILLEBRAND FACTOR IN HUMAN RENAL ALLOGRAFTS

 

Ozdemir BH, Demirhan B, Haberal M*

Departments of Pathology and General Surgery*, Baskent University, Faculty of Medicine

Ankara-Turkey

 

 

Correspondence address:

 

B. Handan  Ozdemir MD

Associate Professor

Department of pathology

Baskent University, Faculty of Medicine

Baglar caddesi  194-6

06700 GOP

Ankara, Turkey

Ph:   +90-312-2126591

Fax: +90-312-2127572

e-mail: handan27@hotmail.com