International Multicenter Study Evaluating Clinical Outcomes Associated with Acute Antibody-Mediated Rejection

S. Corman¹, I. Hirji², E. Brouwer², S. H. Park¹, C. Macahilig³, A. Vergani², T. Bo², P. Wolthoff³, P. Keown⁴

¹Pharmerit International, Bethesda, MD, ²Shire, Cambridge, MA, ³Medical Data Analytics, Parsippany, NJ, ⁴University of British Columbia, Vancouver, BC, Canada

Meeting: 2019 American Transplant Congress

Abstract number: D90

Keywords: Biopsy, Graft failure, Multivariate analysis, Panel reactive antibodies

Session Information

Session Name: Poster Session D: Kidney Acute Antibody Mediated Rejection

Session Type: Poster Session

Date: Tuesday, June 4, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Evaluating factors that impact clinical outcomes of patients with acute antibody-mediated rejection (aAMR) may help manage and improve outcomes following kidney transplant. The objective of this retrospective chart review was to describe clinical characteristics of aAMR patients (pts) under current standard of care and to evaluate clinical predictors and impact of transplant glomerulopathy (TG).

*Methods: Patients from the United States, United Kingdom, France, Spain, Germany, and Italy who had their first aAMR between Jan 1, 2010 and Dec 31, 2015 were included. Medical records were reviewed from the first aAMR episode through the most recent record, loss to follow-up, or death. Descriptive statistics and multivariable regression were used to evaluate clinical predictors of TG and the relationship between TG and graft outcomes.

*Results: Data from 626 pts (mean age at transplant=49 y; 57.4% male) with aAMR were analyzed. Diagnosis of aAMR was made at a median (Quartile [Q] 1-Q3) of 62 (13-153) days post-kidney transplant using biopsy and donor specific antibody (57.2%) or biopsy only (41.5%). Across all countries, 86.7% of pts received at least 1 pharmacologic therapy for treatment of aAMR. TG occurred in 126/626 (20.1%) pts. Median (Q1-Q3) time from first aAMR episode to TG diagnosis was 534 (121-936) days. Pts with a deceased donor (vs a living donor) or peak panel reactive antibodies (PRA) of 51-80% or 81-100% (vs peak PRA 0%) pre-kidney transplant had increased odds of developing TG (Odds Ratio [95% Confidence Interval (CI)]: 2.12 [1.20, 3.74] and 1.97 [1.11, 3.49], respectively). Graft failure was reported in 90/626 (14.5%) pts. When compared with a propensity-score matched cohort of pts without TG, pts with TG had a significantly shorter time to graft failure (P=0.004). At 72 months, Kaplan-Meier estimates showed 57% of pts with TG were free from graft failure vs 90% of pts without TG with a statistically significant increase in graft failure rate (Hazard Ratio [95% CI]: 3.70 [1.67, 8.20]).

*Conclusions: This study, which includes a large, diverse cohort of pts with aAMR demonstrates that among pts with kidney transplants and aAMR, occurrence of TG significantly increases the probability of graft failure, highlighting the importance of managing its progression.

To cite this abstract in AMA style:

Corman S, Hirji I, Brouwer E, Park SH, Macahilig C, Vergani A, Bo T, Wolthoff P, Keown P. International Multicenter Study Evaluating Clinical Outcomes Associated with Acute Antibody-Mediated Rejection [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/international-multicenter-study-evaluating-clinical-outcomes-associated-with-acute-antibody-mediated-rejection/. Accessed June 7, 2025.

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