Protocol Biopsies in ABO-Incompatible Versus ABO-Compatible Living Donor Kidney Transplant Recipients
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).
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 |
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 December 2, 2024.« Back to 2013 American Transplant Congress