Comparing histopathology and graft outcomes in ABO-compatible vs ABO-incompatible kidney transplant recipients with biopsy-proven acute rejection: a propensity score-matched study.

Authors

Sabarinath Shanmugham, Narayan Prasad, Manas Ranjan Patel, Anupma Kaul, Dharmendra Bhadauria, Ravi Kushwaha, Vinita Agrawal

Published in

Journal of nephrology. Oct 16, 2025. Epub Oct 16, 2025.

Abstract

The available literature on graft histology and graft outcomes in kidney transplant recipients (KTRs) with acute rejection after ABO-incompatible and ABO-compatible kidney transplant is scarce.
Among 100 ABO-incompatible kidney transplants (KTx) performed between 2014 and 2019, 37 (37%) developed biopsy-proven acute rejection. A matched cohort of 37 ABO-compatible KTRs with biopsy-proven acute rejection was identified from 97 (7%) patients with biopsy-proven acute rejection, among 680 ABO-compatible KTRs. Matching employed a propensity score using donor age, donor sex, donor GFR, induction agent, HLA mismatch, and maintenance treatment with tacrolimus. The individual BANFF scores [acute (g,i,t,ptc,v) and chronic (ci,ct,cg, cv) scores], and mean BANFF scores between the two groups were compared. We estimated survival in the matched-pairs cohort according to Kaplan-Meier and compared the two groups using the log-rank test.
Acute rejection occurred in the early post transplant phase in 29 (78%) vs. 17 (46%) (P = 0.008), and late in 8 (22%) vs. 20 (54%) (P = 0.008) in ABO-incompatible KTRs and ABO-compatible KTRs, respectively. The mean BANFF scores were similar in ABO-incompatible and ABO-compatible KTRs except for interstitial inflammation, which was significantly higher in ABO-compatible KTRs (1.43 ± 0.728 vs. 1.11 ± 0.516, p = 0.030). The response to antirejection therapy was similar in the two groups. Post-rejection graft survival was significantly shorter in ABO-incompatible KTRs than in ABO-compatible KTRs (80% vs. 92% at one year and 63% vs. 92% at three years (log-rank p = 0.017)).
There were no significant differences between ABO-compatible and ABO-incompatible KTRs in mean BANFF scores in patients with biopsy-proven acute rejection after propensity score-matching except for interstitial inflammation. Post-rejection graft survival was inferior in ABO-incompatible KTRs.

PMID:
41099946
Bibliographic data and abstract were imported from PubMed on 16 Oct 2025.

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