Objective:

To investigate the association between intragraft donor-specific antibodies (gDSA) detected in kidney biopsy eluates and histologic findings in kidney transplant recipients with concurrent serum donor-specific antibodies (sDSA).

Approach:

Key Findings:

• gDSA positivity significantly varied across histologic diagnoses (P = 3.3 × 10-4).
• Highest gDSA positivity was found in C4d-only lesions (100.0%), aABMR (90.9%), and aABMR+TCMR (83.3%).
• Lower gDSA positivity was observed in caABMR (44.4%), no rejection (22.7%), and aTCMR (14.3%).
• The gDSA positive rate in aABMR was significantly higher than in the no-rejection group (P = 0.003; OR 34, 95% CI 3.5–334).
• The sum of gDSA MFI was significantly higher in aABMR, aABMR+TCMR, and C4d-only lesions (P = 0.009, 0.035, and 0.007, respectively).
• No significant difference in the sum of sDSA MFI across histologic groups.

Interpretation:

The presence and intensity of gDSA in kidney transplant recipients with concurrent sDSA correlate with specific histologic findings.

Limitations:

• The study included a small number of biopsies in certain histologic categories, such as C4d-only (n = 3) and IFTA III (n = 2), which may limit the generalizability of findings.

Conclusion:

gDSA may provide additional insights into the immunologic context of histologic variability in kidney transplant recipients with circulating sDSA.

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