*Purpose: Antibody-mediated rejection(AMR) is a major risk factor for graft loss after kidney transplantation. Some AMR appeared within 6 months after kidney transplant, that we called early AMR. Some AMR appeared after 6 months, that we called late AMR. The aim of this study was to compare the differences of clinical characteristics and outcomes between early AMR and late AMR.

*Methods: We retrospectively collected 32 early AMR patients and 48 late AMR patients who were diagnosed by biopsy in our hospital from January 2011 to December 2018. The clinical characteristics such as age, gender, HLA mismatches, PRA levels before transplant, PRA levels on diagnosis, serum creatinine, proteinuria, hematuria, BANFF criteria for biopsy, induction therapy, and immunosuppressive regimen were all recorded. These characteristics and graft survival were compared between early AMR group and late AMR group.

*Results: Serum creatinine on diagnosis were much higher in early AMR group compared to late AMR group(324±156 vs. 213±112 μmol/L, p<0.05). 24-hours proteinuria on diagnosis was also much higher in early AMR group(1.8±0.9 vs. 1.3±0.7g/L, p<0.05). Preformed DSAs were seen more frequently in early AMR group, while de novo DSAs were seen more frequently in late AMR group. In BANFF criteria, g and ptc grade were much higher in early AMR group, while cg and ci grade were much higher in late AMR group. More early AMR were combined with T cell mediate rejection than late AMR(53.1% vs. 27.0%, p<0.05). Response to anti-rejection therapy were better in early AMR group compared to late AMR group(81.3% vs. 29.2%, p<0.01). Kaplan-Meier analysis showed that 1-,3-,5-year graft survival were much better in early AMR group compared to late AMR group(p<0.05). There were no differences of hematuria, PRA levels on diagnosis, induction therapy and immunosuppressive regimen between early AMR and late AMR group(p>0.05).

*Conclusions: Although symptoms of rejection were more severe in early AMR than late AMR, the prognosis were better in early AMR compared to late AMR.

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