Antibody‐mediated rejection implies a poor prognosis in kidney transplantation: Results from a single center

• Published in: Clinical transplantation 2018-10, Vol.32 (10), p.e13392-n/a
• Main Authors: Ciancio, Gaetano, Gaynor, Jeffrey J., Guerra, Giselle, Sageshima, Junichiro, Roth, David, Chen, Linda, Kupin, Warren, Mattiazzi, Adela, Tueros, Lissett, Ruiz, Phillip, Vianna, Rodrigo, Burke, George W.
• Format: Article
• Language: English
• Subjects: antibody‐mediated rejection component; death‐censored graft survival following rejection; renal transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13392

Two major barriers to achieving long‐term graft survival include patient nonadherence in taking the prescribed immunosuppression and antibody‐mediated rejection(AMR). We were therefore interested in determining the prognostic impact of developing an AMR component to rejection in a prospective randomized trial of 200 kidney transplant recipients who received dual induction therapy (rATG combined with either daclizumab or alemtuzumab) and planned early corticosteroid withdrawal. With a median follow‐up of 96 months post‐transplant, 40/200 developed a first BPAR; 9/200 developed a second BPAR. An AMR component to rejection was observed in 70% (28/40) of cases. Percentages having C4d deposition, histopathologic evidence of acute AMR, and presence of DSAs/non‐DSAs at the time of first developing the AMR component were 64.3% (18/28), 60.7% (17/28), and 53.6% (15/28), respectively. Development of an AMR component was associated with a significantly higher death‐censored graft failure rate following rejection in comparison with the patient state of experiencing BPAR but without developing an AMR component (estimated hazard ratio: 4.52, P = 0.01). The observed percentage developing graft failure following development of an AMR component was 53.6% (15/28) vs only 20.0%(3/15) if it was not observed. Actuarial death‐censored graft survival at 60 months following development of an AMR component was 28.3 ± 11.9%. In summary, it appears that more effective AMR prevention/treatment strategies are warranted.