Abstract: TH-PO0947
Effect of Induction Immunosuppressive Regimens on One-Year Protocol Biopsy Findings: A Pathological Perspective in Kidney Transplantation
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Park, Woo Yeong, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Kim, Yaerim, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Paek, Jin hyuk, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Jin, Kyubok, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Han, Seungyeup, Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
- Choe, Misun, Department of Pathology, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Korea (the Republic of)
Background
In kidney transplantation, the choice of induction immunosuppressant significantly influences post-transplant clinical outcomes. Although many centers perform protocol biopsies to monitor graft status, the association between induction immunosuppressant type and pathologic findings remains uncertain.
Methods
We aimed to investigate the association between induction immunosuppressive agents and one-year protocol biopsy findings in kidney transplant recipients (KTRs) between 2017 and 2023. Transplant outcomes and histopathologic changes in one-year protocol biopsies were compared between KTRs who received basiliximab and thymoglobulin.
Results
A one-year protocol biopsy was performed in 88 KTRs (48 from living and 40 from deceased donors). Among them, 45 (51.1%) were considered as nonspecific change, 5 (5.7%), borderline, 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. The protocol biopsy revealed a range of pathological findings despite stable kidney function. Notably, subclinical rejection was observed in 18 (20.4%), while chronic allograft nephropathy was identified in 11 (12.5%) one-year post-transplantation. However, there was no significant difference of baseline characteristics according to the induction immunosuppressant type. 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 was also no significant association between the occurrence of donor specific antibody and subclinical rejection based on the induction immunosuppressant.
Conclusion
This study highlights the importance of protocol biopsy, even when kidney function appears stable, to account for potential pathological changes. Although the type of induction immunosuppressant was not associated with significant differences in the incidence of de novo DSA or rejection, it was associated with distinct histopathologic findings.
Funding
- Government Support – Non-U.S.