Differences in chronic intragraft inflammation between positive crossmatch and ABO-incompatible kidney transplantation

Transplantation. 2014 Nov 27;98(10):1089-96. doi: 10.1097/TP.0000000000000188.


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).

Conclusion: 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • ABO Blood-Group System*
  • Adult
  • Aged
  • Female
  • Graft Rejection / etiology
  • Graft Rejection / immunology
  • Graft Rejection / pathology
  • Graft Survival / immunology
  • Histocompatibility Testing*
  • Humans
  • Inflammation / etiology*
  • Inflammation / immunology
  • Inflammation / pathology
  • Isoantibodies / blood
  • Kidney / immunology
  • Kidney / injuries*
  • Kidney / pathology
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / mortality
  • Living Donors
  • Male
  • Middle Aged
  • Survival Analysis
  • Time Factors
  • Treatment Outcome


  • ABO Blood-Group System
  • Isoantibodies