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Chronic Active Antibody Mediated Rejection: 3 Month Response Rates to Treatment and Predictors of Graft Survival

F. Aziz, M. Jorgenson, S. Parajuli, N. Garg, V. Manchala, E. Yousif, D. Mandelbrot, L. Hidalgo, M. Mohamed, W. Zhong, A. Djamali

University of Wisconsin, Madison, WI

Meeting: 2022 American Transplant Congress

Abstract number: 1403

Keywords: Kidney, Rejection

Topic: Clinical Science » Kidney » 45 - Kidney Chronic Antibody Mediated Rejection

Session Information

Session Name: Kidney Chronic Antibody Mediated Rejection

Session Type: Poster Abstract

Date: Monday, June 6, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: There is limited information on effectiveness of treatment and predictors of graft survival following chronic active antibody mediated rejection (cABMR) in kidney transplant recipients (KTR).

*Methods: We describe response to therapy in 82 consecutive kidney transplant recipients diagnosed with cABMR between 01/2017 and 08/2020. Treatment consisted of pulse steroids/IVIG ± rituximab. A positive response was defined if eGFR returned within 10% of baseline, proteinuria (UPC) decline > 25%, DSA decline > 50%, or MVI (ptc + g) score = 0 at three months. We further identified predictors of graft survival using univariate and multivariable analyses.

*Results: The study included 82 patients. Mean time from transplant to cABMR was 10 ± 7.1 years. Mean ptc, g, C4d, and cg Banff scores at index biopsy were 1.1, 2.1, 0.2, and 2, respectively. Mean eGFR and UPC were 38 mL/min and 1.6 g/g. Thirty (37%) patients lost their allograft during the mean follow-up of 2.4 yrs. At 3-month, eGFR, UPC, DSA, and MVI response rates were 27%, 49%, 7%, and 19% respectively, in the group which received treatment with pulse steroids and IVIG (n=41). The eGFR, UPC, DSA, and MVI response was 66%, 61%, 20%, and 69%, respectively in the group that received steroids, IVIG and rituximab. Univariate analysis identified rituximab (HR=0.13, p=0.0001, 95%Cl 0.05 to 0.34), response in eGFR (HR=0.03, p=0.001, 95% Cl 0.004 to 0.26), UPC (HR=0.38, p=0.01, 95%Cl 0.18 to 0.82), and DSA (HR=0.11, p=0.004, 95%Cl 0.02 to 0.49) as predictors of death-censored graft survival. Multivariate analysis only retained eGFR response (HR=0.12, p=0.01, 95%Cl 0.02 to 0.64).

*Conclusions: Our study suggests that eGFR response at 3-month after initial biopsy is the best predictor of graft survival in patients with cABMR. Short-term histological and immunological response were not independently associated with graft survival.

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To cite this abstract in AMA style:

Aziz F, Jorgenson M, Parajuli S, Garg N, Manchala V, Yousif E, Mandelbrot D, Hidalgo L, Mohamed M, Zhong W, Djamali A. Chronic Active Antibody Mediated Rejection: 3 Month Response Rates to Treatment and Predictors of Graft Survival [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/chronic-active-antibody-mediated-rejection-3-month-response-rates-to-treatment-and-predictors-of-graft-survival/. Accessed May 9, 2025.

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