New insights into rejection agents in kidney transplants

Researchers recently uncovered important insights into a newly defined rejection entity in kidney transplantation, which may improve risk stratification of patients after transplantation. The research will be presented at ASN Kidney Week 2024, October 23-27.

Kidney transplant rejection continues to threaten the long-term success of kidney transplants, and microvascular inflammation (inflammation within the capillaries) plays a pivotal role in graft failure. The complex nature of this inflammation makes it a major challenge in clinical practice. In response, the International Banff Classification, the global standard for diagnosing transplant rejection, has redefined antibody-mediated rejection diagnosis by introducing two new categories of microvascular inflammation. They are mild microvascular inflammation where antibody-mediated rejection is likely and microvascular inflammation where antibody-mediated rejection is absent. Antibody-mediated response.

In a groundbreaking study that analyzed more than 16,000 biopsies from nearly 7,000 kidney transplant recipients, researchers found that many cases initially thought to be non-rejection were now defined as found that it was reclassified into the category of microvascular inflammation. Importantly, reclassified patients with microvascular inflammation in the absence of antibody-mediated responses showed an increased risk of graft failure compared to patients with no evidence of rejection, suggesting that this new classification The importance of was emphasized.

Recognizing these phenotypes may improve risk stratification and support more individualized management of kidney transplant patients. We encourage large-scale studies in other organ transplants where microvascular inflammation is also a key feature of antibody-mediated rejection. ”

Aurélie Sagnier, first author, pathologist, researcher at the Paris Institute for Transplantation and Organ Regeneration