The Impact of High Immunological Sensitization on Donor Kidney Morphology in High-Risk Transplant Recipients
Abstract
Kidney transplantation is widely recognized as the most effective treatment for patients with end-stage renal disease, providing improved survival and quality of life compared to long-term dialysis. Nevertheless, immunologically high-risk recipients remain vulnerable to adverse transplant outcomes due to preexisting sensitization and the presence of donor-specific antibodies. High sensitization is commonly associated with previous blood transfusions, pregnancies, or prior transplantations and is considered a major risk factor for antibody-mediated rejection. The present study aimed to investigate the impact of high sensitization on donor kidney morphology in immunologically high-risk patients undergoing kidney transplantation. Histopathological characteristics of donor kidneys were evaluated and correlated with the immunological status of recipients. Particular attention was given to glomerular, vascular, and tubulointerstitial alterations that may influence graft function and survival. The findings demonstrated that highly sensitized recipients were more likely to receive donor kidneys exhibiting significant morphological changes, including vascular thickening, interstitial fibrosis, tubular injury, and glomerular abnormalities. These structural alterations were associated with an increased incidence of delayed graft function and early post-transplant complications. Furthermore, a strong relationship was observed between elevated sensitization levels and the severity of histological abnormalities, suggesting that immunological factors may contribute to both pre-transplant and post-transplant graft injury. The study highlights the importance of comprehensive immunological assessment and detailed morphological evaluation of donor kidneys before transplantation. Understanding the interaction between recipient sensitization and donor kidney morphology may improve risk stratification, optimize donor-recipient matching, and contribute to the development of individualized therapeutic strategies aimed at enhancing graft survival and long-term transplant success in immunologically high-risk patient populations.
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References
- Zhang R. Donor-Specific Antibodies in Kidney Transplant Recipients. Clinical Journal of the American Society of Nephrology. 2018;13(1):182-192. https://doi.org/10.2215/CJN.00700117
- Puttarajappa C, Shapiro R, Tan HP. Antibody-Mediated Rejection in Kidney Transplantation: A Review. Journal of Transplantation. 2012;2012:193724. https://doi.org/10.1155/2012/193724
- Santos AH Jr, Belal A, Badra S, et al. Common predictors of adverse outcomes in adult deceased donor kidney transplant recipients with varying sensitization. American Journal of Clinical and Experimental Urology. 2023;11(3):235-248. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331002/
- Garces JC, Giusti S, Staffeld-Coit C, et al. Antibody-Mediated Rejection: A Review. The Ochsner Journal. 2017;17(1):46-55. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349348/
- Valenzuela NM, Reed EF. Antibody-mediated rejection across solid organ transplants: manifestations, mechanisms, and therapies. Journal of Clinical Investigation. 2017;127(7):2492-2504. https://doi.org/10.1172/JCI90597
- Thongprayoon C, Miao J, Jadlowiec CC, et al. Differences between Very Highly Sensitized Kidney Transplant Recipients as Identified by Machine Learning Consensus Clustering. Medicina. 2023;59(5):977. https://doi.org/10.3390/medicina59050977
- Pouliquen E, Koenig A, Chen CC, et al. Recent advances in renal transplantation: antibody-mediated rejection takes center stage. F1000Prime Reports. 2015;7:51. https://doi.org/10.12703/P7-51
- Dunn TB, Noreen H, Gillingham K, et al. Revisiting Traditional Risk Factors for Rejection and Graft Loss after Kidney Transplantation. American Journal of Transplantation. 2011;11(10):2132-2143. https://doi.org/10.1111/j.1600-6143.2011.03640.x
- Baldwin WM III, Valujskikh A, Fairchild RL. Mechanisms of antibody-mediated acute and chronic rejection of kidney allografts. Current Opinion in Organ Transplantation. 2016;21(1):7-14. https://doi.org/10.1097/MOT.0000000000000262
- Kim EJ, Kim SJ, Huh KH, et al. Clinical significance of tacrolimus intra-patient variability on kidney transplant outcomes according to pre-transplant immunological risk. Scientific Reports. 2021;11(1):12158. https://doi.org/10.1038/s41598-021-91630-4
- Lee H, Park Y, Ban TH, et al. Synergistic impact of pre-sensitization and delayed graft function on allograft rejection in deceased donor kidney transplantation. Scientific Reports. 2021;11(1):15983. https://doi.org/10.1038/s41598-021-95327-6
- Bestard O, Thaunat O, Bellini MI, et al. Alloimmune Risk Stratification for Kidney Transplant Rejection. Transplant International. 2022;35:10138. https://doi.org/10.3389/ti.2022.10138