PURPOSE: The diagnostic criteria for antibody-mediated rejection (AMR) in pancreas transplantation (PTx) is evolving. The incidence and long-term effect of AMR have not been well-described. Herein, we aim to characterize the frequency and impact of AMR on patient and graft outcomes in a modern and diverse cohort of PTx.

METHODOLOGY: We performed a retrospective analysis of 383 PTx between January 2006 and July 2015 evaluated for graft dysfunction in the first post-PTx year. PTx were grouped by rejection grade using biopsy-proven (BP) and clinically-suspected (CS) criteria. Univariate and multivariate analyses were performed to determine potential risk factors for rejection and graft failure. BP and CS rejection rates were correlated with patient and graft survival.

RESULTS: Univariate analysis (Table 1) identified the following recipient risk factors for AMR: age (p=0.02), gender (p=0.04), and peak PRA (p<0.001). Recipients with >1 PTx were found to be borderline significant (p=0.06). Multivariate analysis confirmed peak PRA to be the only significant risk factor for AMR (p<0.001). Patient survival after 1-year was similar for all groups while graft survival was significantly reduced for patients with any type of rejection (Figure 1). The AMR/Mixed groups exhibited worse outcomes than the CMR group (p=0.005). After adjusting for recipient age, gender, and number of prior PTx, rejection grouping remained a significant predictor of graft survival.

CONCLUSION: AMR or mixed rejection appears to portend a worse graft survival than CMR. Long-term patient survival does not seem to be affected by rejection status at 1 year post-PTx.

CITATION INFORMATION: Serrano O, Vock D, Finger E, Kandaswamy R, Sutherland D, Dunn T. Antibody-Mediated Rejection in Pancreas Transplantation. Am J Transplant. 2016;16 (suppl 3).

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