Abstract
Introduction: Microvascular inflammation (MVI) is a hallmark feature of antibody-mediated rejection (ABMR), but its prognostic significance when it occurs with T-cell-mediated rejection (TCMR) in the absence of other ABMR features remains unclear.
Methods: We examined the association between pure TCMR phenotypes, defined by the presence or absence of MVI, and graft survival using restricted mean survival time (RMST), and assessed interactions with rejection involving a “v” lesion.
Results: Among 1614 recipients with first biopsy-proven pure TCMR (2010–2023), 85% had no MVI, 8% subthreshold MVI (Banff glomerulitis [g] + peritubular capillaritis [ptc] = 1), and 7% with MVI (g + ptc ≥ 2). Compared with TCMR without MVI, recipients with TCMR + MVI (hazard ratio [HR]; 95% confidence intervals [CI] 1.57 [1.06–2.34]) had a higher risk of all-cause graft loss, whereas subthreshold MVI was not associated with increased risk. The 5-year RMST was lowest in the MVI group (3.93 [3.53–4.26]), compared with the subthreshold group (4.39 [4.11– 4.60]) and the no MVI group (4.32 [4.24–4.40]). Rejection with a “v” lesion modified this association. Recipients with TCMR + MVI and positive “v” lesion had a 2.77-fold higher risk of graft loss (2.77 [1.64–4.67]), whereas no excess risk was observed in those without vascular lesions.
Conclusion: Pure TCMR with MVI, particularly in the setting of a “v” lesion, represents a high-risk phenotype associated with poorer graft survival, warranting mechanistic investigations and targeted therapeutic strategies.
Keywords
cellular rejection, kidney transplant, microvascular inflammation, registry, T cells rejection
Document Type
Journal Article
Date of Publication
10-1-2026
Article Number
106707
ISSN
24680249
Volume
11
Issue
10
Publication Title
Kidney International Reports
Publisher
Elsevier
School
Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Recommended Citation
Lim, W. H., Wang, J., Teixeira-Pinto, A., Ho, J., Gately, R., Sabanayagam, D., Ooi, E., Boroumand, F., Bakar, K. S., Zhu, L., Pilmore, H., Mulley, W., Li, J., Nankivell, B., Kanellis, J., Nickerson, P., Wiebe, C., & Wong, G. (2026b). Kidney allograft outcomes in borderline and T cell-mediated rejection with microvascular inflammation. Kidney International Reports, 11(10), 106707. https://doi.org/10.1016/j.ekir.2026.106707