Andrew Bentall1, Loren P Herrera, Lynn D Cornell, Manuel A Moreno Gonzales, Patrick G Dean, Walter D Park, Manish J Gandhi, Jeffrey L Winters, Mark D Stegall. 1. 1 Division of Transplantation Surgery, Mayo Clinic, Rochester, MN. 2 Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom. 3 Department of Anatomic Pathology, Mayo Clinic, Rochester, MN. 4 Division of Transfusion Medicine, Mayo Clinic, Rochester, MN. 5 Address correspondence to: Mark D. Stegall, M.D., Division of Transplantation Surgery and von Liebig Transplant Center, Mayo Clinic, Rochester, MN, U.S.A., Mayo Clinic, 200 First Street, SW Rochester, MN 55905.
Abstract
BACKGROUND: ABO-incompatible kidney transplantations (ABOiKTxs) seem to have better long-term outcomes than positive crossmatch kidney transplantations (+XMKTxs). METHODS: This study aimed to assess the differences in chronic injury on histologic findings on 1- and 5-year surveillance biopsies and the clinical outcomes in living-donor kidney transplantations performed between May 1999 and November 2006 including 102 +XMKTxs, 73 ABOiKTxs, and 652 conventional KTxs. RESULTS: Although 5-year patient survival was similar between groups, graft loss between 1 and 5 years was similar in ABOiKTx (2.6% per year) and conventional KTx (1.7% per yr), and both were lower than that of +XMKTx (5.8% per year). At 5 years, renal function was similar in ABOiKTx and conventional KTx, and both were higher than that of +XMKTx, which had higher rates of inflammation and chronic glomerulopathy on both 1- and 5-year biopsies. Despite having evidence of less chronic injury, ABOiKTx showed a higher rate of intragraft complement activation (C4d deposition) at 5 years compared with +XMKTx (77.8% vs. 18.9%, P<0.001). CONCLUSION: These data suggest that +XMKTxs have high rates of chronic inflammation at 1 and 5 years after transplantation, which may explain the higher rates of graft loss and lower renal function compared with other factors such as anti-donor antibody or intragraft complement deposition.
BACKGROUND:ABO-incompatible kidney transplantations (ABOiKTxs) seem to have better long-term outcomes than positive crossmatch kidney transplantations (+XMKTxs). METHODS: This study aimed to assess the differences in chronic injury on histologic findings on 1- and 5-year surveillance biopsies and the clinical outcomes in living-donor kidney transplantations performed between May 1999 and November 2006 including 102 +XMKTxs, 73 ABOiKTxs, and 652 conventional KTxs. RESULTS: Although 5-year patient survival was similar between groups, graft loss between 1 and 5 years was similar in ABOiKTx (2.6% per year) and conventional KTx (1.7% per yr), and both were lower than that of +XMKTx (5.8% per year). At 5 years, renal function was similar in ABOiKTx and conventional KTx, and both were higher than that of +XMKTx, which had higher rates of inflammation and chronic glomerulopathy on both 1- and 5-year biopsies. Despite having evidence of less chronic injury, ABOiKTx showed a higher rate of intragraft complement activation (C4d deposition) at 5 years compared with +XMKTx (77.8% vs. 18.9%, P<0.001). CONCLUSION: These data suggest that +XMKTxs have high rates of chronic inflammation at 1 and 5 years after transplantation, which may explain the higher rates of graft loss and lower renal function compared with other factors such as anti-donor antibody or intragraft complement deposition.
Authors: Carrie A Schinstock; Andrew J Bentall; Byron H Smith; Lynn D Cornell; Matthew Everly; Manish J Gandhi; Mark D Stegall Journal: Am J Transplant Date: 2018-12-15 Impact factor: 8.086
Authors: Manuel Moreno Gonzales; Andrew Bentall; Walter K Kremers; Mark D Stegall; Richard Borrows Journal: J Am Soc Nephrol Date: 2016-03-09 Impact factor: 10.121
Authors: Annelies E de Weerd; Jan A J G van den Brand; Hanneke Bouwsma; Aiko P J de Vries; Ine Ph M M Dooper; Jan-Stephan F Sanders; Maarten H L Christiaans; Franka E van Reekum; Arjan D van Zuilen; Frederike J Bemelman; Azam S Nurmohamed; Madelon van Agteren; Michiel G H Betjes; Margriet F C de Jong; Marije C Baas Journal: Transpl Int Date: 2021-11-11 Impact factor: 3.842