Chronic Active Antibody Mediated Rejection (cABMR): Treatment, Outcomes and Predictors of Graft Loss in a Large Case Series
1University of Wisconsin, Madison, WI
2University of Michigan, Ann Arbor, MI.
Meeting: 2015 American Transplant Congress
Abstract number: A94
Keywords: Alloantibodies, Graft survival, Rejection
Session Information
Session Name: Poster Session A: Kidney Antibody Mediated Rejection
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: CABMR is a barrier to long-term kidney allograft survival. There is little information on the treatment and outcomes of kidney transplant recipients with cABMR.
Methods: A single institution study of 124 patients diagnosed with cABMR of the kidney between 2006 and 2012. All biopsies were based on clinical indication and met Banff 2013 criteria for cABMR.
Results: The diagnosis of cABMR was made at a mean of 5.6 ± 3.8 years post transplant. Patients were followed for 10±4 years (range 2.7 to 20.3) post-transplant. Mean DSA at time of diagnosis was 12,000 ±12,700 MFI. The majority (53.2%) of patients had class II antibodies, 32.2% had both class I and II antibodies and a minority (14.5%) had class I DSA only. At the time of diagnosis, mean C4d and cg scores were 2.6±0.7 and 2.2±0.8 respectively. Mean chronicity score (ci+ct+cg+cv) was 6.2±2 (Median 6) and mean MVI score (ptc+g) was 2.1±1.4 (Median 2).
There were 31 (25%) patient deaths and 94 (76%) graft losses, which occurred at a mean of 1.5±1.4 years after cABMR diagnosis. Patients were treated with steroid bolus (93%), IVIG (87%), rituximab (30%), plasma exchange (PLEX, 13%) and Thymoglobulin (10%). Treatment of any kind was associated with superior graft survival at 3 years from diagnosis of cABMR (34% vs 10%, p=0.05).
In unadjusted analyses, cv>1 (HR 1.6, CI 1.0 to 2.6, p=0.04), DSA > 7,000 MFI (HR 1.7, CI 1.1 to 2.5, p=0.01) were independently associated with graft loss. Rituximab (HR 0.52, CI 0.33 to 0.83, p=0.01) and Thymoglobulin treatment (HR 0.42, CI 0.18 to 0.98, p=0.04) were independently associated with graft protection. In multivariate analyses, only MFI > 7,000 MFI (HR 1.6, CI 1.0 to 2.4, p=0.04) and rituximab (HR 0.54, CI 0.34 to 0.88, p=0.01) were retained as significant.
Conclusion: cABMR is associated with poor graft survival. In this large case series of kidney transplant recipients with cABMR, DSA intensity was identified as a predictor of graft loss and rituximab therapy as a predictor of graft survival. Rituximab may have beneficial effects in preventing graft demise. Randomized clinical trials are needed to confirm these findings and define the best strategy to treat cABMR.
To cite this abstract in AMA style:
Redfield R, Ellis T, Zhong W, Zens T, Rizzari M, Scalea J, Jacobson L, Mandelbrot D, Parajuli S, Muth B, Mohamed M, Panzer S, Astor B, Samaniego M, Kaufman D, Djamali A. Chronic Active Antibody Mediated Rejection (cABMR): Treatment, Outcomes and Predictors of Graft Loss in a Large Case Series [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/chronic-active-antibody-mediated-rejection-cabmr-treatment-outcomes-and-predictors-of-graft-loss-in-a-large-case-series/. Accessed May 8, 2025.« Back to 2015 American Transplant Congress