title: Histological Analysis in ABO-Compatible and ABO-Incompatible Kidney Transplantation by Performance of 3- and 12-Month Protocol Biopsies.
abstract: ABO-incompatible (ABO-I) kidney transplantation (KTx) is an established procedure to expand living donor sources. Although graft and patient survival rates are comparable between ABO-compatible (ABO-C) and ABO-I KTx, several studies have suggested that ABO-I KTx is associated with infection. Additionally, the histological findings and incidence of antibody-mediated rejection under desensitization with rituximab and plasmapheresis remain unclear.
  
  
  
  We reviewed 327 patients who underwent living-donor KTx without preformed donor-specific antibodies (ABO-C, n = 226; ABO-I, n = 101). Patients who underwent ABO-I KTx received 200 mg/body of rituximab and plasmapheresis, and protocol biopsy (PB) was planned at 3 and 12 months. We compared the PB findings, cumulative incidence of acute rejection in both PBs and indication biopsies, infection, and patient and graft survivals.
  
  
  
  The 3- and 12-month PBs were performed in 85.0% and 79.2% of the patients, respectively. Subclinical acute rejection occurred in 6.9% and 9.9% of patients in the ABO-C and ABO-I groups at 3 months (P = 0.4) and in 12.4% and 10.1% at 12 months, respectively (P = 0.5). The cumulative incidence of acute rejection determined by both PBs and indication biopsies was 20.5% and 19.6%, respectively (P = 0.8). The degrees of microvascular inflammation and interstitial fibrosis/tubular atrophy were comparable. Polyomavirus BK nephropathy was found in 2.7% and 3.0% of patients in the ABO-C and ABO-I groups, respectively (P = 1.0). The incidence of other infections and the graft/patient survival rates were not different.
  
  
  
  Analyses using 3- and 12-month PBs suggested comparable allograft pathology between ABO-C and ABO-I KTx under desensitization with low-dose rituximab and plasmapheresis.
authors.affiliation: 1 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2 Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 3 Division of Surgery, Harasanshin Hospital, Fukuoka, Japan. 4 Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. 5 Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Masutani
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tsuchimoto
authors.forename: Kei
authors.initials: K
authors.lastname: Kurihara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Okabe
authors.forename: Hidehisa
authors.initials: H
authors.lastname: Kitada
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Okumi
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tanabe
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuruya
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001706:Biopsy; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000473:pathology* / Q000517:prevention & control; D006085:Graft Survival; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000276:immunology / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology / Q000276:immunology; D010956:Plasmapheresis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D000069283:Rituximab