title: Differences in chronic intragraft inflammation between positive crossmatch and ABO-incompatible kidney transplantation.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Division of Transplantation Surgery, Mayo Clinic, Rochester, MN. 2 Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom. 3 Department of Anatomic Pathology, Mayo Clinic, Rochester, MN. 4 Division of Transfusion Medicine, Mayo Clinic, Rochester, MN. 5 Address correspondence to: Mark D. Stegall, M.D., Division of Transplantation Surgery and von Liebig Transplant Center, Mayo Clinic, Rochester, MN, U.S.A., Mayo Clinic, 200 First Street, SW Rochester, MN 55905.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bentall
authors.forename: Loren P
authors.initials: LP
authors.lastname: Herrera
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Cornell
authors.forename: Manuel A Moreno
authors.initials: MA
authors.lastname: Gonzales
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Dean
authors.forename: Walter D
authors.initials: WD
authors.lastname: Park
authors.forename: Manish J
authors.initials: MJ
authors.lastname: Gandhi
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology / Q000473:pathology; D006085:Graft Survival / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007249:Inflammation / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D007518:Isoantibodies / Q000097:blood; D007668:Kidney / Q000276:immunology / Q000293:injuries* / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies