PATHOLOGICAL INSIGHTS INTO ONE-YEAR PROTOCOL BIOPSIES: INFLUENCE OF INDUCTION IMMUNOSUPPRESSION IN KIDNEY TRANSPLANTATION

 

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https://storage.unitedwebnetwork.com/files/1099/ba4416c1a4f154289e2058b1074b178a.pdf
PATHOLOGICAL INSIGHTS INTO ONE-YEAR PROTOCOL BIOPSIES: INFLUENCE OF INDUCTION IMMUNOSUPPRESSION IN KIDNEY TRANSPLANTATION

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Woo Yeong
Park
Woo Yeong Park wy-my@hanmail.net Keimyung University School of Medicine, Keimyung University Dongsan Hospital Division of Nephrology, Department of Internal Medicine Daegu Korea (Republic of) *
Jin Kyung Kwon 250176@dsmc.or.kr Keimyung University School of Medicine, Keimyung University Dongsan Hospital Division of Nephrology, Department of Internal Medicine Daegu Korea (Republic of) -
Yaerim Kim yaerim86@gmail.com Keimyung University School of Medicine, Keimyung University Dongsan Hospital Division of Nephrology, Department of Internal Medicine Daegu Korea (Republic of) -
Jin Hyuk Paek novawang@naver.com Keimyung University School of Medicine, Keimyung University Dongsan Hospital Division of Nephrology, Department of Internal Medicine Daegu Korea (Republic of) -
Kyubok Jin mdjin922@gmail.com Keimyung University School of Medicine, Keimyung University Dongsan Hospital Division of Nephrology, Department of Internal Medicine Daegu Korea (Republic of) -
Hyeong Chan Shin chan@dsmc.or.kr Keimyung University School of Medicine, Keimyung University Dongsan Hospital Department of Pathology Daegu Korea (Republic of) -
Misun Choe msc@dsmc.or.kr Keimyung University School of Medicine, Keimyung University Dongsan Hospital Department of Pathology Daegu Korea (Republic of) -
Seungyeup Han hansy@dsmc.or.kr Keimyung University School of Medicine, Keimyung University Dongsan Hospital Division of Nephrology, Department of Internal Medicine Daegu Korea (Republic of) -
 
 
 
 
 
 
 

Induction immunosuppressant significantly influences post-transplant clinical outcomes, especially according to the immunological status in kidney transplant recipients (KTRs). Recently, protocol biopsies have been performed to predict post-transplant clinical outcomes, but the association between induction immunosuppressant type and pathologic findings remains still uncertain.

We investigated the association between induction immunosuppressive agents and one-year protocol biopsy findings in KTRs with stable allograft function between 2017 and 2023. Post-transplant outcomes and histopathological patterns in one-year protocol biopsies were compared between KTRs who received basiliximab and thymoglobulin.

A one-year protocol biopsy was performed in 88 KTRs (48 from living and 40 from deceased donors). Among them, 45 (51.1%) showed nonspecific changes, 5 (5.7%), borderline, 18 (20.3%), subclinical rejection: 4 (4.5%), acute T-cell mediated rejection (TCMR), 3 (3.4%), chronic active TCMR, 10 (11.4%), acute antibody-mediated rejection (ABMR), 1 (1.1%), chronic active ABMR, 4 (4.5%), de novo glomerulopathy/recurrence of primary disease, 4 (4.5%) calcineurin inhibitor toxicity, 11 (12.5%), interstitial fibrosis and tubular atrophy, and 1 (1.1%), BK virus nephropathy. There was no significant difference of baseline characteristics between basiliximab and thymoglobulin groups. The number of global sclerosis, cg score, ci score, t-IFTA, ct score, cv score, ah score, and aah score was significantly higher in basiliximab group than thymoglobulin group. However, there were no significant differences of the occurrence of de novo donor specific antibody (DSA) and subclinical rejection between them.

Although kidney function is stable within one-year after transplant, protocol biopsies accounts for potential pathological changes. This study showed that induction immunosuppressant type was not significantly associated with the development of de novo DSA and subclinical rejection, but use of basiliximab was associated with more pronounced chronic allograft injury than thymoglobulin.

Kewords