*Purpose: Little is known about how pathology findings on biopsy correlate with outcomes in pediatric kidney transplant patients with antibody mediated rejection (AMR). We aimed to review the Banff scores from patients with AMR and correlate with 1 year post treatment outcomes.

*Methods: We collected data from 6 centers within the Pediatric Nephrology Research Consortium to review the treatment patterns. Pediatric renal transplant recipients from 0 to 18 years old at time of transplant with biopsy proven AMR between 12/31/2009-12/31/2017 and followed for 12 consecutive months were included. Microvascular Injury Score (MVI) = g+ptc; Chronic inflammation (CI) = ci+ct+cv+(cgX2); Acute Inflammation (AI)= g+ptc+C4d; Interstitial Fibrosis and Tubular Atrophy (IFTA)= ci+ct. Results were considered statistically significant if P<0.05. Categorical variables are presented as relative frequencies and normally distributed continuous variables are presented as means ± standard deviations with differences assessed by two-tailed t-tests.

*Results: We have reviewed 42 AMR episodes from 40 patients to date. 52.4% (22/42) were mixed AMR/acute cellcular rejection (ACR). 26.2% (11/42) lost their graft by 1 year post AMR treatment. 27.3% (3/11) were pure AMR, and the others were mixed ACR and AMR. 37 samples were available for further Banff analysis. Twelve patients (32.4%) had a > 50% decrease in GFR at one year and 25(67.6%) had a < 50% decrease in GFR 1 year post treatment. Of those with a <50% GFR decrease, there was more MVI, AI and less IFTA (Table 1).

*Conclusions: Those with more chronic changes (IFTA) and less acute changes (MVI and AI) had more GFR loss at 1 year post treatment. While this is a large pediatric study, the numbers are still small. Larger studies will need to confirm these findings.

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