title: Histologic findings one year after positive crossmatch or ABO blood group incompatible living donor kidney transplantation.
abstract: Recent protocols have allowed successful positive crossmatch (+XM) and ABO incompatible (ABOI) kidney transplantation, although their long-term outcome is not clear. To begin to assess this issue we compared protocol biopsies performed 12 months posttransplant in 37 +XM, 24 ABOI and 198 conventional allografts. Although the majority in all three groups had only minimal histologic changes, transplant glomerulopathy (TG) was significantly increased in +XM (22% vs. 13% ABOI vs. 8% conventional, p = 0.015), and correlated with prior humoral rejection (HR) by multivariate analysis (odds ratio 17.5, p < or = 0.0001). Patients with a prior history of HR also had a significant increase in interstitial fibrosis (No HR 54% vs. HR 86%, p = 0.045). In the absence of HR no difference in histologic changes was seen between groups, although all three groups had a demonstrable mild increase in interstitial fibrosis from biopsies performed at the time of transplant. Thus, although HR is associated with an increase in TG, in its absence allograft histology is similar in +XM, ABOI and conventional allografts 1 year posttransplant.
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic and Foundation, Rochester, Minnesota, USA. gloor.james@mayo.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Gloor
authors.forename: F G
authors.initials: FG
authors.lastname: Cosio
authors.forename: D J
authors.initials: DJ
authors.lastname: Rea
authors.forename: H M
authors.initials: HM
authors.lastname: Wadei
authors.forename: J L
authors.initials: JL
authors.lastname: Winters
authors.forename: S B
authors.initials: SB
authors.lastname: Moore
authors.forename: S R
authors.initials: SR
authors.lastname: DeGoey
authors.forename: D J
authors.initials: DJ
authors.lastname: Lager
authors.forename: J P
authors.initials: JP
authors.lastname: Grande
authors.forename: M D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology* / Q000378:metabolism; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000276:immunology* / Q000378:metabolism / Q000473:pathology*; D003181:Complement C4 / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D000017:ABO Blood-Group System; D003181:Complement C4