Early Antibody-Mediated Rejection Portends Worse Long-Term Renal Graft and Patient Survival
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.
| 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.
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.« Back to 2013 American Transplant Congress