Retrospective Analysis of Kidney Transplant Recipients with Antibody-Mediated Rejection.
1Nephrology and Renal Transplant, Hospital Clinic de Barcelona, Barcelona, Spain
2Apheresis Unit, Department of Hemotherapy and Hemostasis, Hospital Clinic de Barcelona, Barcelona, Spain
3Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
Meeting: 2017 American Transplant Congress
Abstract number: B71
Keywords: Alloantibodies, Graft survival, Rejection
Session Information
Session Name: Poster Session B: Antibody Mediated Rejection in Kidney Transplant Recipients II
Session Type: Poster Session
Date: Sunday, April 30, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Acute antibody mediated rejection (AMR) is a major cause of allograft loss.
We retrospectively reviewed all kidney allograft recipients between 2002 and March 2016. Investigated the variables associated with response to treatment and graft survival.
Table 1 summarizes the clinical and immunological characteristic of patients. The median follow-up was 43.5 months (range 0.5-141).
| Table1: | n, mean (% or +/-SD) |
| Male/Female (n/n) | 60/42 |
| Mean age AMR | 49,4 (+/- 13,6) years |
| Prior transplant | 56 (54,9%) |
| Deceased donor | 64 (62,7%) |
| NHBD | 6 (5,8%) |
| ABOi | 15 (14,7%) |
| Hypersensitized | 54 (52,9) |
| Rejection Luminex + | 56 (54,9%) |
| Pretransplant DSA + | 26 (25,5%) |
| De novo DSA + | 17 (16,7) |
| Immunosuppression (%) | |
| Ciclosporine | 9 (8,8%) |
| FK | 81 (79,4%) |
| MTOR | 21 (20,6%) |
| Micophenolate | 81 (79,4%) |
| Prednisone | 90 (88,2%) |
| Rejection characteristics | |
| Early/Late (<> 1 year) | 81 (79%)/ 21 (20,6%) |
| Time RT- AMR (days) early/late | Median 17 (+/-84) / 1824 (+/-1547) |
| Concomitant Cellular rejection | 26 (25,5%) |
All patients received plasma exchange(PE) (median number 6+/-3, mean total volume 21L) and IV immunoglobulin (200mg/kg after every two PE). Also 88 (86.3%) rituximab (mean 736mg).
The response to treatment was better in early (less than 1 year) 72% vs late rejection 23%, OR 0.11 (p<0.001). The mean graft survival at 2 years was 72.4%+-7.9 and 46%+-11.7 months in early and late rejection respectively. Tubulitis greater to 1 and presence of IFTA were associated with no response to treatment (OR 2.49 and 8.3, p 0.04 and 0.01) and graft loss during the first year (OR 4.06 and 2.8, p 0.039 and 0.047).
There were 43 (42.2%) graft loss, 24 in the first year after treatment.
In the next 2 years after treatment were 84 episodes of infections that required hospital admissionin in 49 patients. A Charlson comorbidity index 5 or greater was associated with more infections OR 3.5 (p 0.003), and mortality OR 35 (p<0.001).
In conclusion, response to treatment and outcomes depends of earliness of rejection, comorbidities, presence of IFTA and tubulitis greater 1.
CITATION INFORMATION: Piñeiro G, Desousa E, Villarreal J, Lozano M, Cid J, Sole M, Oppenheimer F, Diekmann F. Retrospective Analysis of Kidney Transplant Recipients with Antibody-Mediated Rejection. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Piñeiro G, Desousa E, Villarreal J, Lozano M, Cid J, Sole M, Oppenheimer F, Diekmann F. Retrospective Analysis of Kidney Transplant Recipients with Antibody-Mediated Rejection. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/retrospective-analysis-of-kidney-transplant-recipients-with-antibody-mediated-rejection/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress