Histologic Findings of Antibody-Mediated Rejection in ABO Blood-Group-Incompatible Living-Donor Kidney Transplantation

Mary E. Fidler, James M. Gloor, Donna J. Lager, Timothy S. Larson, Matthew D. Griffin, Stephen C. Textor, Thomas R. Schwab, Mikel Prieto, Scott L. Nyberg, Michael B. Ishitani, Joseph P. Grande, Paul A. Kay, Mark D. Stegall

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


The purpose of this study was to characterize the histology of antibody-mediated rejection (AMR) in ABO blood-group-incompatible (ABOI) kidney transplants as well as on protocol biopsies performed at the time of stable allograft function. Between 5/99 and 1/02, we performed 32 ABOI kidney transplants (13 A2, 19 non-A2 blood-group living donors). Nineteen biopsies were performed for allograft dysfunction, and 127 protocol biopsies were performed 0, 3, 7, 14, 28 days and 3 and 12 months post transplant. Twenty-five of 32 patients have functioning allografts (mean 585 days post transplant). Nine of 32 (28%) developed clinical AMR. Biopsy revealed glomerular thrombi (78%), mesangiolysis (78%), peritubular capillary C4d staining (56%) and neutrophil infiltration (67%), interstitial hemorrhage and necrosis (56%) and arteriolar thrombi (33%). Subclinical AMR was diagnosed by protocol biopsies in four patients. Findings consisted of glomerular thrombi (100%), mesangiolysis (25%), and C4d staining (100%). In late protocol biopsies performed 214-420 days post transplant, mild mesangiolysis was seen in 2/17 (11.7%), and C4d immunostaining was detected in 3/12 (25%). AMR is characterized by glomerular thrombi, mesangiolysis, peritubular capillary neutrophil infiltration interstitial hemorrhage, necrosis, and C4d deposition. Glomerular thrombi appear early in AMR and may appear prior to graft dysfunction.

Original languageEnglish (US)
Pages (from-to)101-107
Number of pages7
JournalAmerican Journal of Transplantation
Issue number1
StatePublished - Jan 2004


  • ABO blood group
  • Antibodies
  • Blood group incompatibility
  • Graft rejection
  • Kidney transplant

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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