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Abstract: TH-PO838

Histological Analysis of Protocol Biopsies and Outcomes in ABO-Incompatible Renal Transplants: A Single-Centre Prospective Study from West India

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Prabhakar, Aniketh, Sigma Hospital, Mysore, Karnataka, India
  • Gang, Sishir D., Mulijibhai Patel Urological Hospital, Nadiad, Gujarat, India
Background

ABO Incompatible renal transplants(ABOiKtx) provide a viable option to increase donor pool for ever increasing need. Outcomes are comparable to ABO compatible counterparts. Limited data exist regarding role of Protocol Biopsies and the impact of histological changes on the outcomes of ABO incompatible renal transplants.

Methods

We Included all ABO incompatible renal transplant patients from April 2017 and have completed 6 months of follow up till march 2019 . A Protocol biopsy was done when eligible at 3 and 12 months post transplant. All the patients were analyzed for outcomes.

Mehtodology for Biopsy: Biopsy samples were processed at our hospital, 2 cores were taken for histology and IF, C4D done by IF. Protocol biopsies were assessed and deemed adequate for interpretation by pathologists and graded according to the revised Banff classification 2017 .

Results

34 patients who underwent ABOiKTX between April 2017 to March 2018 were included. 23/34 patients underwent biopsies at 3 months[17 protocol and 6 indication biopsy(5 didnot consent, 2 were on antiplatelets, and 4 grafts were lost)] and20/23 at 12 months[17 protocol and 3 indication biopsy(2 graft were lost and one was on antiplatelets)].Protocol biopsies revealed no subclinical rejections. 3/17 and 8/17 had C4d positivity without rejection at 3 and 12 months respectively. Presence of C4d at 3 months did not significantly influence GFR or Chronicity on biopsy at 12 months. Analysis of indication biopsies 6/23 revealed 1 IFTA,1 ABMR 4 TCMR at 3 months. Overall 6 patients had TMA on biopsies(Indication biopsies) over 1 year follow up. At 1 year Patient survival was 94% and death censored graft survival of 87% (Causes- Graft artery thrombosis, HUS and Rejections). Subgroup analysis revealed no difference in graft outcomes with lower or higher doses of Rituximab for desesnitization (p= 0.6).

Conclusion

Presence of C4D positivity or Tubulo-interstitial inflammation at 3 months was not associated with reduced GFR or increased fibrosis at end of 1 year. Lack of subclinical rejections were encouraging. Those with normal biopsies at 3 months had good outcomes at 1 year. Graft Survival and patient survival were comparable with other centres.