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Background <p>The available literature on graft histology and graft outcomes in kidney transplant recipients (KTRs) with acute rejection after ABO-incompatible and ABO-compatible kidney transplant is scarce.</p> Methods <p>Among 100 ABO-incompatible kidney transplants (KTx) performed between 2014 and 2019, 37 (37%) developed biopsy-proven acute rejection. A matched cohort of 37 ABO-compatible KTRs with biopsy-proven acute rejection was identified from 97 (7%) patients with biopsy-proven acute rejection, among 680 ABO-compatible KTRs. Matching employed&#xa0;a propensity score using donor age, donor sex, donor GFR, induction agent, HLA mismatch, and maintenance&#xa0;treatment with tacrolimus. The individual BANFF scores [acute (g,i,t,ptc,v) and chronic (ci,ct,cg, cv) scores], and mean BANFF scores between the two groups were compared. We estimated survival in the matched-pairs cohort according to Kaplan-Meier&#xa0;and compared the two groups using the log-rank test.</p> Results <p>Acute rejection occurred in the early post transplant phase in&#xa0;29 (78%) vs. 17 (46%) (<i>P</i> = 0.008), and late in 8 (22%) vs. 20 (54%) (<i>P</i> = 0.008) in ABO-incompatible KTRs and ABO-compatible KTRs, respectively. The mean BANFF scores were similar in ABO-incompatible and ABO-compatible KTRs except for interstitial inflammation, which was significantly higher in ABO-compatible KTRs (1.43 ± 0.728 vs. 1.11 ± 0.516, <i>p</i> = 0.030). The response to antirejection therapy was similar in the two groups. Post-rejection graft survival was significantly shorter in ABO-incompatible KTRs than in ABO-compatible KTRs (80% vs. 92% at one year and 63% vs. 92% at three years (log-rank <i>p</i> = 0.017)).</p> Conclusion <p>There were no significant differences between ABO-compatible and ABO-incompatible KTRs in mean BANFF scores in patients with biopsy-proven acute rejection after propensity score-matching except for interstitial inflammation. Post-rejection graft survival was inferior in ABO-incompatible KTRs.</p> Graphical abstract <p></p>

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Comparing histopathology and graft outcomes in ABO-compatible vs ABO-incompatible kidney transplant recipients with biopsy-proven acute rejection: a propensity score-matched study

  • 期刊论文

  • 发表日期：

    2025年10月16日

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  • Sabarinath Shanmugham,
  • Narayan Prasad,
  • Manas Ranjan Patel,
  • Anupma Kaul,
  • Dharmendra Bhadauria,
  • Ravi Kushwaha,
  • Vinita Agrawal

摘要

Background

The available literature on graft histology and graft outcomes in kidney transplant recipients (KTRs) with acute rejection after ABO-incompatible and ABO-compatible kidney transplant is scarce.

Methods

Among 100 ABO-incompatible kidney transplants (KTx) performed between 2014 and 2019, 37 (37%) developed biopsy-proven acute rejection. A matched cohort of 37 ABO-compatible KTRs with biopsy-proven acute rejection was identified from 97 (7%) patients with biopsy-proven acute rejection, among 680 ABO-compatible KTRs. Matching employed a propensity score using donor age, donor sex, donor GFR, induction agent, HLA mismatch, and maintenance treatment with tacrolimus. The individual BANFF scores [acute (g,i,t,ptc,v) and chronic (ci,ct,cg, cv) scores], and mean BANFF scores between the two groups were compared. We estimated survival in the matched-pairs cohort according to Kaplan-Meier and compared the two groups using the log-rank test.

Results

Acute rejection occurred in the early post transplant phase in 29 (78%) vs. 17 (46%) (P = 0.008), and late in 8 (22%) vs. 20 (54%) (P = 0.008) in ABO-incompatible KTRs and ABO-compatible KTRs, respectively. The mean BANFF scores were similar in ABO-incompatible and ABO-compatible KTRs except for interstitial inflammation, which was significantly higher in ABO-compatible KTRs (1.43 ± 0.728 vs. 1.11 ± 0.516, p = 0.030). The response to antirejection therapy was similar in the two groups. Post-rejection graft survival was significantly shorter in ABO-incompatible KTRs than in ABO-compatible KTRs (80% vs. 92% at one year and 63% vs. 92% at three years (log-rank p = 0.017)).

Conclusion

There were no significant differences between ABO-compatible and ABO-incompatible KTRs in mean BANFF scores in patients with biopsy-proven acute rejection after propensity score-matching except for interstitial inflammation. Post-rejection graft survival was inferior in ABO-incompatible KTRs.

Graphical abstract