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Kidney Week

Abstract: SA-OR101

Tertiary Lymphoid Tissues in Protocol Biopsies Predict Progressive Graft Dysfunction in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Lee, Yu ho, CHA University, Sungnam, Korea (the Republic of)
  • Sato, Yuki, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • Saito, Mitsuru, Akita University Graduate School of Medicine, Akita, Japan
  • Fukuma, Shingo, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • Fujiyama, Nobuhiro, Akita University Hospital, Akita, Japan
  • Satoh, Shigeru, Akita University Hospital, Akita, Japan
  • Lee, Sangho, Kyung Hee University Hospital at Gangdong, Seoul, Korea (the Republic of)
  • Habuchi, Tomonori, Akita University Graduate School of Medicine, Akita, Japan
  • Yanagita, Motoko, Kyoto University Graduate School of Medicine, Kyoto, Japan

Tertiary lymphoid tissues (TLTs) are inducible ectopic lymphoid tissues found in chronic inflammatory organs. Previous studies have documented TLT formation in transplanted kidneys with rejection, but their clinical relevance remains controversial. Moreover, the evidences of TLTs in transplanted kidney without rejection are limited. In this study, we examined the frequency and staging of TLTs in protocol biopsy samples without the sign of rejection, and analyzed their effects on renal function in stable kidney transplant recipients.


A total of 181 patients who lacked clinical risk factors for poor graft survival, such as biopsy-proven acute rejection, were selected among those who underwent living donor kidney transplantation. We analyzed serial protocol biopsies (0-hour, 1-month, 6-month, and 12-month) and evaluated TLTs using novel staging methods we had recently established. TLTs were defined as organized lymphocyte aggregates with signs of proliferation, and their stages were determined by the absence (stage I) or presence (stage II) of follicular dendritic cells, which support the formation of B cell area.


Although only 5.1% of patients exhibited TLTs at 0-hour biopsy, the prevalence increased to almost 50% at 1-month after transplantation and was maintained at the similar levels for one year. Stage II TLTs increased gradually over time, from 2.8% at 1-month to 18.0% at 12-month biopsy. Patients with no or stage I TLTs had stable graft function over 5 years, whereas those with stage II TLTs exhibited progressive graft dysfunction. (Figure 1) These advanced TLTs were associated with severe tubular inflammation and atrophy at 1 year post-transplantation. Finally, pre-transplantation rituximab dramatically attenuated the development of stage II TLTs.


TLTs were commonly found in protocol biopsies of transplanted kidneys, and stage II TLTs predict progressive decline in graft function in kidney transplant recipients even in the absence of rejection

Trends in eGFR according to TLT stages


  • Government Support - Non-U.S.