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Published on: September 6, 2017
Biopsy-based Transcriptomics in Banff 2022 Antibody Mediated Rejection Categories
Petra Hruba1, Eva Girmanova1, Dusan Harmacek2
1Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Kidney International Reports
|June 8, 2026
Summary
Biopsy-based transcriptomics (BBT) effectively diagnoses microvascular inflammation (MVI) in kidney transplants, especially in cases of probable antibody-mediated rejection (AMR). This molecular approach shows promise for refining AMR diagnostics beyond current histological standards.
Area of Science:
- Nephrology
- Transplant Immunology
- Molecular Diagnostics
Background:
- Biopsy-based transcriptomics (BBT) is a valuable tool for diagnosing antibody-mediated rejection (AMR) in kidney allografts.
- However, its utility in validating Banff 2022 classifications for probable AMR and microvascular inflammation (MVI) associated with donor-specific antibodies (DSA) and C4d requires further investigation.
Purpose of the Study:
- To evaluate the performance of BBT in classifying various forms of AMR, including probable AMR and MVI, using a large cohort of kidney allograft biopsies.
- To compare the diagnostic accuracy of molecular markers with traditional histological assessments for predicting long-term graft survival.
Main Methods:
- Analysis of 562 kidney allograft biopsies using histology and the Molecular Microscope Diagnostic System (MMDx).
- Biopsies were categorized into active AMR spectrum lesions, combined active-chronic lesions with transplant glomerulopathy (cg), chronic AMR, and controls.
- Classification involved assessing active AMR, probable AMR, MVI (with or without cg), and DSA-/C4d- status.
Main Results:
- Molecular AMR was detected in a significant proportion of biopsies with active AMR (51%), MVI (43-56%), and chronic-active AMR (63%), but was rare in chronic AMR (6%).
- AMR probability classifier (AMRprob) scores were elevated in probable AMR and MVI groups compared to controls, and comparable across active AMR, chronic-active AMR, and MVI groups.
- Both molecular and histological models demonstrated similar performance in predicting 3-year graft survival, with concordance rates of 0.84 and 0.82, respectively.
Conclusions:
- BBT primarily reflects microvascular inflammation (MVI) rather than donor-specific antibodies (DSA) in kidney allografts.
- BBT is particularly informative for diagnosing probable AMR and MVI-positive biopsies.
- Molecular and histological assessments show comparable efficacy in predicting long-term kidney allograft survival.