The Histological Picture of Indication Biopsies in the First 2 Weeks after Kidney Transplantation.

Publisher: Wolters Kluwer Health Country of Publication: United States NLM ID: 101271570 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1555-905X (Electronic) Linking ISSN: 15559041 NLM ISO Abbreviation: Clin J Am Soc Nephrol Subsets: MEDLINE

Publication: 2023- : Hagerstown, MD : Wolters Kluwer Health
Original Publication: Washington, D.C. : American Society of Nephrology, c2005-

Delayed Graft Function/*pathology ; Graft Rejection/*pathology ; Inflammation/*pathology ; Kidney/*pathology ; Kidney/*physiopathology ; Kidney Transplantation/*adverse effects; Adult ; Age Factors ; Aged ; Antibodies/blood ; Autografts/pathology ; Autografts/physiopathology ; Biopsy ; Cold Ischemia/adverse effects ; Delayed Graft Function/etiology ; Female ; Genotype ; Graft Rejection/diagnosis ; Graft Rejection/immunology ; Graft Survival ; HLA Antigens/genetics ; HLA Antigens/immunology ; Humans ; Inflammation/immunology ; Kidney Tubules/pathology ; Male ; Microvessels/pathology ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Time Factors

Background and Objectives: In preclinical studies, ischemia-reperfusion injury and older donor age are associated with graft inflammation in the early phase after transplantation. In human kidney transplantation, impaired allograft function in the first days after transplantation is often adjudicated to donor- and procedure-related characteristics, such as donor age, donor type, and ischemia times.
Design: , setting, participants, & measurements In a cohort of 984 kidney recipients, 329 indication biopsies were performed within the first 14 days after transplantation. The histologic picture of these biopsies and its relationship with alloimmune risk factors and donor- and procedure-related characteristics were studied, as well as the association with graft failure. Multivariable Cox models were applied to quantify the cause-specific hazard ratios for early rejection and early inflammatory scores, adjusted for potential confounders. For quantification of hazard ratios of early events for death-censored graft failure, landmark analyses starting from day 15 were used.
Results: Early indication biopsy specimens displayed microvascular inflammation score ≥2 in 30% and tubulointerstitial inflammation score ≥2 in 49%. Rejection was diagnosed in 186 of 329 (57%) biopsies and associated with the presence of pretransplant donor-specific HLA antibodies and the number of HLA mismatches, but not nonimmune risk factors in multivariable Cox proportional hazards analysis. In multivariable Cox proportional hazards analysis, delayed graft function, the graft dysfunction that prompted an early indication biopsy, HLA mismatches, and pretransplant donor-specific HLA antibodies were significantly associated with a higher risk for death-censored graft failure, whereas early acute rejection was not.
Conclusions: Indication biopsies performed early after kidney transplantation display inflammatory changes related to alloimmune risk factors. Nonimmune risk factors for ischemia-reperfusion injury, such as cold and warm ischemia time, older donor age, and donor type, were not identified as strong risk factors for early inflammation after human kidney transplantation.
(Copyright © 2020 by the American Society of Nephrology.)

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Keywords: acute allograft rejection; delayed graft function; ischemia-reperfusion injury; kidney biopsy; kidney transplantation

0 (Antibodies)
0 (HLA Antigens)

Date Created: 20200812 Date Completed: 20211117 Latest Revision: 20230421

20240829

PMC7536761

10.2215/CJN.04230320

32778537