Abstract: TH-PO1057
Clinical Outcomes of Isolated Microvascular Inflammation in Kidney Transplant Recipients
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Alsaedi, Zainulabdeen S., Washington University in St Louis, St. Louis, Missouri, United States
- Abdulsattar, Dahlia A., Washington University in St Louis, St. Louis, Missouri, United States
- Yaseen Alsabbagh, Dema, Washington University in St Louis, St. Louis, Missouri, United States
- Ikrai, Hamza, Washington University in St Louis, St. Louis, Missouri, United States
- Messias, Nidia Cordeiro, Washington University in St Louis, St. Louis, Missouri, United States
- Alhamad, Tarek, Washington University in St Louis, St. Louis, Missouri, United States
Background
Isolated MVI in kidney transplant recipients (KTRs) without DSA or C4d has emerged as an entity associated with worse graft function
Methods
A retrospective cohort study of KTRs with biopsy-proven isolated MVI with negative C4d staining at a single center between Jan 2018 and Dec 2025. An initial cohort of 406 patients with MVI and negative C4d staining was identified. 26 patients were included in the final analysis after exclusion of patients with DSAs, recurrent glomerular disease, acute cellular rejection with g=0 lesions, and those without dd-cfDNA testing within 3 months of biopsy after chart review
Primary outcomes included changes in eGFR and proteinuria at 3, 6, and 12 months after biopsy. Secondary outcomes included graft failure, death, and development of rejection
Results
Isolated MVI cohort (N=26) was predominantly white (73%) with a mean age of 59 yrs, and 38% were female; 50% had non HLA antibodies, 58% received IVIG/anti CD20, and 27% had advanced fibrosis. Graft loss occurred in 39% and death in 23%, with no biopsy proven rejection events. Mean eGFR showed no significant adjusted decline through 12 months (−3.7 mL/min/1.73m2 p=0.094). Proteinuria outcome showed non significant 24% adjusted reduction at 12 months (p=0.072).
MVI treatment group demonstrated better numerical differences with a statistical trend at 6 months interval compared to no treatment group, reinforcing a favorable trend.
Conclusion
Isolated MVI showed no significant adjusted decline in eGFR. Graft loss and mortality remained the same. The effect on treatment on eGFR trajectory in our cohort, although was statistically insignificant, highlights the need for larger sample size to examine the impact of treatment on MVI in particular. Given the limitations, multicenter studies with larger cohorts are essential to define the long term impact of isolated MVI on graft function and clinical outcomes.
The eGFR plot shows patients' trajectories in grey, treatment group in orange, and no treatment group in blue at different time intervals