Abstract: FR-PO1175
Graft Survival in Different Kidney Allograft Rejection Phenotypes: An Analysis of 2,166 Biopsies
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Santithanmakorn, Chayanan, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Udomkarnjananun, Suwasin, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background
Acute rejection remains a major cause of graft loss after kidney transplantation, yet the long-term impact of distinct rejection phenotypes and histopathologic lesions is incompletely defined.
Methods
We conducted a retrospective cohort study of 747 kidney transplant recipients at King Chulalongkorn Memorial Hospital (2010–2024), including 2,166 allograft biopsies. Rejection phenotypes and Banff lesion scores were modeled as time-varying covariates. Graft failure was analyzed using competing-risk regression with death as a competing event. Principal component analysis (PCA) was used to identify dominant patterns of histologic injury.
Results
Rejection was associated with a higher risk of graft failure, with substantial heterogeneity across phenotypes. At 5 years, graft failure incidence was 3.0% without rejection, compared with 7.6% in borderline TCMR, 17.1% in acute TCMR, 15.9% in active ABMR, and 54.3% in chronic active TCMR. At 10 years, graft failure increased to 9.3%, 22.1%, 44.9%, 42.2%, and 91.7%, respectively, with similarly poor outcomes in mixed rejection (72.3%). Increasing severity of key Banff lesions (g, ptc, i, t) was independently associated with graft failure. PCA identified three major injury patterns—tubulointerstitial inflammation, microvascular inflammation, and chronic injury—all of which were associated with graft failure and demonstrated improved discrimination compared with conventional Banff-based classification.
Conclusion
Rejection phenotypes confer markedly different long-term risks of graft failure, with the worst outcomes observed in chronic active TCMR and mixed rejection. Integrating time-varying histopathologic data with composite injury patterns may enhance risk stratification and inform long-term management in kidney transplant recipients.
Evolution and dynamic transition of rejection phenotypes over time.