Protocol Biopsies in ABO-Incompatible Versus ABO-Compatible Living Donor Kidney Transplant Recipients

A. Sanchez-Escuredo, F. Diekmann, I. Revuelta, M. Solé, J. Cid, M. Lozano, M. Blasco, J. Campistol, F. Oppenheimer

Nephrology and Transplant, H. Clinic, Barcelona, Spain
Pathology, H. Clinic, Barcelona, Spain
Haematology and Haemotherapy, H. Clinic, Barcelona, Spain

Meeting: 2013 American Transplant Congress

Abstract number: B912

Introduction: Short and medium term ABO-incompatible kidney transplant results are comparable with ABO-compatible kidney transplants (KT). Little is known about the histologic evolution of protocol biopsies (PKB) of ABO-I kidneys.Objective: To compare the histological parameters of PKB at 3 and 12 months after ABO-c and ABO-i KT.

Methods: prospective observational study. From 2009-2011 152 consecutive living-donor KT were performed: 128ABO-c and 24ABO-i. Desensitization Protocol ABO-i:Conditioning with rituximab, plasma exchange (PE) or immunoadsorption (IA) and immunoglobulins iv. 2 PE or IA after KT. Indication biopsies were performed if patient showed deterioration of renal function.

Results: At 3 and 12 months PKB were offered to all patients and performed in 89/17 ABO-c/ABO-i patients. 59adequate biopsy samples were obtained (≥ 10 glomeruli and arteries ≥ 2) to perform complete Banff score: ABO-c /ABO-i 48/11. Clinical biopsy-proven and treated acute rejection during the first year ABO-c/ABO-i: cellular rejection 12.6%/8.4% (pNS), AMR 3.9%/8.3% (pNS), Borderline 3.1%/12.5% (p = 0.004). In PKB there were no differences between groups except C4d positivity in the ABO-I group at 3months and 1year(p <0.001).

Complete Banff score in protocol biopsies:
	ABO-c 3 m (48)	ABO-i 3 m (11)	ABO-c 1 y(48)	ABO-i 1 y(11)	p 3m c-i	p-1y c-i
Interstitial inflammation (i)	0,17±0,44	0	0,25±0,49	0,4±0,5	NS	NS
Tubulitis (t)	0	0	0,2±0,46	0,2±0,42	NS	NS
Glomerulitis (g)	0,06±0,33	0,1±0,33	0,18±0,49	0,1±0,31	NS	NS
Arteriolar Hyaline Thickening (ah)	0	0,1±0,33	0,2±0,39	0	NS	NS
Peritubular capilaritis (ptc)	0,06±0,33	0	0,2±0,59	0,3±0,48	NS	NS
Interstitial inflammation (ti)	0,14±0,43	0,2±0,49	0,52±0,69	0,4±0,51	NS	NS
Hyaline arteriolar (aah)	0	0	0,08±0,25	0	NS	NS
Interstitial fibrosis thickening (ci)	0,29±0,45	0,6±0,5	0,66±0,68	0,5±0,52	NS	NS
Tubular artrophy (ct)	0,35±0,48	0,7±0,47	0,68±0,6	0,4±0,51	NS	NS
Vascular Fibrous intimal thickening (cv)	0,46±0,65	0,5±0,52	0,43±0,66	0,5±0,52	NS	NS
Allograft glomerulopathy (cg)	0	0,1±0,33	0,08±0,33	0	NS	NS
Mesangial matrix (mm)	0	0,1±0,33	0,08±0,33	0	NS	NS
C4d	0,08±0,48	2,4±0,84	0,1±0,66	2,3±1,1	< 0,001	< 0,001

NS: not significative

Conclusion: ABO-i renal allografts show a higher incidence of borderline clinical rejection during the first year. Moreover, diffuse C4d+ staining in the absence of clinical antibody mediated-rejection was observed.

To cite this abstract in AMA style:

Sanchez-Escuredo A, Diekmann F, Revuelta I, Solé M, Cid J, Lozano M, Blasco M, Campistol J, Oppenheimer F. Protocol Biopsies in ABO-Incompatible Versus ABO-Compatible Living Donor Kidney Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/protocol-biopsies-in-abo-incompatible-versus-abo-compatible-living-donor-kidney-transplant-recipients/. Accessed May 17, 2025.

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