Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Background: Antibody-mediated rejection (AMR) is recognized as the major cause of kidney allograft loss. Despite an aggressive treatment, prognosis is usually poor. The aim of our study was to analyze the graft survival and the risk factors of treatment failure in AMR.
Methods: Patient with AMR were selected between 01/03/2011 and 02/11/2015 according to Banff classification. Recipients characteristics, renal function, proteinuria, immunodominant DSA (DSAi), histologic lesions on transplant biopsy and the modality of treatment were recorded. Treatment failure was defined as a decrease of GFR>25% or graft loss 12 months after treatment of AMR.
Result: 43 patients developed an AMR with a median time after transplantation were 4.7±4.4 years. DSA were preformed for 5 patients and de novo for 38 patients. At diagnosis (D0), mean serum creatinine was 214+/-102[micro]mol/L, mean GFR (MDRD) was 33.9±14.3ml/min/1.73m2, and the ratio proteinuria/ creatininuria was 1.05+/-1.46g/g. All patients received plasma exchange (n=36) or Protein A immunoadsorption (n=7) with a mean number of sessions of 8.3. Twenty-one patients (48.8%) received high dose IVIG, and 28 patients (65.1%) received Rituximab (1 or 2 infusions at 375mg/m2). Graft survival at 1 year was 86%. Sixteen patients presented a treatment failure: graft loss (n = 6) or decrease in GFR> 25% (n = 10).
Risk factors associated with treatment failure in univariate analysis were, at D0 : cg score (HR: 2.1, p=0.001), mm score (HR: 3.6, p = 0.001), and tubular atrophy (ct) (HR: 2.24, P=0.03) and, during follow-up : deterioration of GFR between D0-M3 (HR: 0.93, p = 0.01), proteinuria at M3 (HR 1.01, p=0.001), and the evolution of the MFI for DSAi between D0-M3 (HR: 1.01, p=0.05). In multivariate analysis, only mesangial hypertrophy at diagnosis (mm score) and the evolution of the MFI for DSAi between D0-M3 were associated with treatment failure.
The score of mesangial hypertrophy (mm) and the evolution of the MFI for DSAi between D0-M3 are the only independent risk factors of AMR treatment failure.
CITATION INFORMATION: Pernin V, Szwarc I, Kanouni T, Garrigue V, Serre J, Delmas S, Mourad G, Le Quintrec M. Risk Factors of Treatment Failure in Antibody Mediated Rejection. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Pernin V, Szwarc I, Kanouni T, Garrigue V, Serre J, Delmas S, Mourad G, Le M. Risk Factors of Treatment Failure in Antibody Mediated Rejection. [abstract]. Am J Transplant. 2017; 17 (suppl 3). http://atcmeetingabstracts.com/abstract/risk-factors-of-treatment-failure-in-antibody-mediated-rejection/. Accessed November 18, 2017.
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