title: Histologic findings of antibody-mediated rejection in ABO blood-group-incompatible living-donor kidney transplantation.
abstract: The purpose of this study was to characterize the histology of antibody-mediated rejection (AMR) in ABO blood-group-incompatible (ABOI) kidney transplants as well as on protocol biopsies performed at the time of stable allograft function. Between 5/99 and 1/02, we performed 32 ABOI kidney transplants (13 A2, 19 non-A2 blood-group living donors). Nineteen biopsies were performed for allograft dysfunction, and 127 protocol biopsies were performed 0, 3, 7, 14, 28 days and 3 and 12 months post transplant. Twenty-five of 32 patients have functioning allografts (mean 585 days post transplant). Nine of 32 (28%) developed clinical AMR. Biopsy revealed glomerular thrombi (78%), mesangiolysis (78%), peritubular capillary C4d staining (56%) and neutrophil infiltration (67%), interstitial hemorrhage and necrosis (56%) and arteriolar thrombi (33%). Subclinical AMR was diagnosed by protocol biopsies in four patients. Findings consisted of glomerular thrombi (100%), mesangiolysis (25%), and C4d staining (100%). In late protocol biopsies performed 214-420 days post transplant, mild mesangiolysis was seen in 2/17 (11.7%), and C4d immunostaining was detected in 3/12 (25%). AMR is characterized by glomerular thrombi, mesangiolysis, peritubular capillary neutrophil infiltration interstitial hemorrhage, necrosis, and C4d deposition. Glomerular thrombi appear early in AMR and may appear prior to graft dysfunction.
authors.affiliation: Department of Laboratory Medicine, Division of Anatomic Pathology, Mayo Foundation and Clinic, Rochester, MN, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fidler
authors.forename: James M
authors.initials: JM
authors.lastname: Gloor
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Lager
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Larson
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Griffin
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Textor
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Schwab
authors.forename: Mikel
authors.initials: M
authors.lastname: Prieto
authors.forename: Scott L
authors.initials: SL
authors.lastname: Nyberg
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ishitani
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Grande
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kay
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D001706:Biopsy; D001787:Blood Group Incompatibility; D005920:Glomerular Mesangium / Q000473:pathology; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007668:Kidney / Q000276:immunology; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D009336:Necrosis; D009504:Neutrophils / Q000276:immunology; D013154:Spleen / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents