Differences in chronic intragraft inflammation between positive crossmatch and ABO-incompatible kidney transplantation

Andrew Bentall, 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

Research output: Contribution to journalArticle

12 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1089-1096
Number of pages8
JournalTransplantation
Volume98
Issue number10
DOIs
StatePublished - Jan 1 2014

Keywords

  • ABO incompatible
  • Chronic histologic injury
  • HLA antibodies
  • Kidney transplant
  • Positive crossmatch

ASJC Scopus subject areas

  • Transplantation

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    Bentall, A., Herrera, L. P., Cornell, L. D., Gonzales, M. A. M., Dean, P. G., Park, W. D., Gandhi, M. J., Winters, J. L., & Stegall, M. D. (2014). Differences in chronic intragraft inflammation between positive crossmatch and ABO-incompatible kidney transplantation. Transplantation, 98(10), 1089-1096. https://doi.org/10.1097/TP.0000000000000188