Histological Analysis in ABO-Compatible and ABO-Incompatible Kidney Transplantation by Performance of 3- and 12-Month...

Area of Science:

• Nephrology
• Transplantation Immunology
• Surgical Pathology

Background:

• ABO-incompatible kidney transplantation (KTx) expands donor options.
• Concerns exist regarding infection and rejection in ABO-incompatible KTx despite comparable survival rates.
• Histological findings and rejection incidence under desensitization protocols require clarification.

Purpose of the Study:

• To compare histological findings, rejection rates, infection incidence, and survival between ABO-compatible and ABO-incompatible kidney transplant recipients.
• To evaluate the efficacy of desensitization protocols involving rituximab and plasmapheresis in ABO-incompatible KTx.

Main Methods:

• Retrospective review of 327 living-donor kidney transplant recipients (226 ABO-compatible, 101 ABO-incompatible).
• ABO-incompatible recipients received rituximab and plasmapheresis; protocol biopsies were performed at 3 and 12 months.
• Comparison of biopsy findings, acute rejection incidence, infection rates, and patient/graft survival.

Main Results:

• Protocol biopsies showed comparable subclinical acute rejection rates at 3 and 12 months between groups (6.9% vs 9.9% at 3 months, 12.4% vs 10.1% at 12 months).
• Overall acute rejection incidence (biopsy-proven and protocol biopsies) was similar (20.5% vs 19.6%).
• Microvascular inflammation, fibrosis, BK nephropathy, other infections, and survival rates were not significantly different.

Conclusions:

• Desensitization with low-dose rituximab and plasmapheresis results in comparable allograft pathology in ABO-incompatible kidney transplantation versus ABO-compatible transplantation.
• The study supports the safety and efficacy of ABO-incompatible kidney transplantation with current desensitization protocols.