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Early Antibody-Mediated Rejection Portends Worse Long-Term Renal Graft and Patient Survival

B. Orandi, E. Chow, K. Van Arendonk, J. Montgomery, N. Gupta, R. Montgomery, D. Segev

Surgery, Johns Hopkins University, Baltimore, MD

Meeting: 2013 American Transplant Congress

Abstract number: B981

Antibody-mediated rejection (AMR) incidence will increase as incompatible renal transplantation becomes more common. Our objective was to determine the effects of early (<1 year) AMR on long-term outcomes.

All adult, renal transplants performed at our center from 1/00-2/12 were reviewed to identify AMR based on histologic, immunogenetic, and clinical data. Controls were matched 5:1 on PRA, gender, donor and blood type by iterative expanding radius matching. Survival and graft failure were augmented via SRTR linkage. Survival was tested with log-rank tests and modeled with K-M curves.

The 201 patients with early AMR were similar to matched controls.

Characteristics by Development of Early Antibody-Mediated Rejection
  Overall (1204) AMR (201) No AMR (1003) P-value
Recipient Age 45.4 (12.6) 45.1 (12.7) 45.5 (12.6) 0.77
Donor Age 41.2 (13.2) 42.3 (12.5) 41.0 (13.3) 0.19
Non-White 398 (33.1%) 65 (32.3%) 333 (33.2%) 0.81
Deceased Donor Creatinine >1.5 mg/dL 95 (26.0%) 15 (26.8%) 75 (24.0%) 0.88
Matched Characteristics
Median Peak PRA (IQR) 90 (33-98) 88 (38-100) 90 (33-98) –
Deceased Donor 366 (30.4%) 56 (27.9%) 310 (30.9%) –
Live Donor 838 (69.6%) 145 (72.1%) 693 (69.1%) –
Female 735 (61.0%) 118 (58.7%) 617 (61.5%) –
Type A 344 (34.3%) 65 (32.3%) 409 (34.0%) –
Type B 163 (13.5%) 32 (15.9%) 131 (13.1%) –
Type AB 19 (1.6%) 5 (2.5%) 14 (1.4%) –
Type O 613 (50.9%) 99 (49.3%) 514 (51.3%) –

AMR patients had significantly worse graft and patient survival. In AMR patients, 1, 5 and 10-year graft survival were 86, 74 and 55%, versus 95, 88 and 77% in controls.

One, 5 and 10-year patient survival were 91, 80 and 63% in AMR patients and 97, 87 and 66% in controls.

Early AMR has significant long-term effects on patient and graft survival, suggesting the need for more AMR prevention strategies to mitigate the expected increase in AMR incidence.

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To cite this abstract in AMA style:

Orandi B, Chow E, Arendonk KVan, Montgomery J, Gupta N, Montgomery R, Segev D. Early Antibody-Mediated Rejection Portends Worse Long-Term Renal Graft and Patient Survival [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/early-antibody-mediated-rejection-portends-worse-long-term-renal-graft-and-patient-survival/. Accessed May 23, 2025.

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