Faculty Collaboration Database

Subclinical Antibody-mediated Rejection After Kidney Transplantation: Treatment Outcomes. Transplantation 2019 Aug;103(8):1722-1729

Date

12/07/2018

Pubmed ID

30507740

DOI

10.1097/TP.0000000000002566

Scopus ID

2-s2.0-85070611340 (requires institutional sign-in at Scopus site)   68 Citations

Abstract

BACKGROUND: Antibody-mediated rejection (AMR) is a leading cause of morbidity and mortality after kidney transplantation. Early diagnosis and treatment of subclinical AMR based on the donor-specific antibody (DSA) testing may result in better outcomes.

METHODS: We tested this hypothesis in 220 kidney transplant recipients who underwent an indication or DSA-based surveillance protocol biopsies between March 1, 2013 and December 31, 2016. Patients were divided into 3 groups: clinical AMR (n = 118), subclinical AMR (n = 25), or no rejection on protocol biopsy (controls; n = 77).

RESULTS: Both clinical and subclinical AMR groups underwent similar treatment including plasmapheresis, pulse steroids, IVIG, and rituximab (P = ns). Mean follow-up after AMR was 29.5 ± 16.8 months. There were 2 (3%), 2 (8%), and 54 (46%) death-censored graft failures in the control, subclinical, and clinical AMR groups, respectively (P < 0.001). Graft outcomes were similar in the subclinical rejection and control groups. In adjusted Cox regression analysis, only clinical rejection (hazards ratio [HR], 4.31; 95% confidence interval [CI], 1.01-18.94; P = 0.05) and sum chronicity scores (HR, 1.16; 95% CI, 1.01-1.35; P = 0.03) were associated with increased risk of graft failure, while estimated glomerular filtration rate at time of biopsy (HR, 0.98; 95% CI, 0.96-0.99; P = 0.01) was associated with decreased risk of graft failure.

CONCLUSIONS: Our study suggests that early diagnosis and treatment of subclinical AMR using DSA monitoring may improve outcomes after kidney transplantation.

Author List

Parajuli S, Joachim E, Alagusundaramoorthy S, Blazel J, Aziz F, Garg N, Muth B, Mohamed M, Mandelbrot D, Zhong W, Djamali A

Author

Emily Joachim MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Allografts
Biopsy
Drug Therapy, Combination
Female
Follow-Up Studies
Glucocorticoids
Graft Rejection
Graft Survival
HLA Antigens
Humans
Immunologic Factors
Isoantibodies
Kidney
Kidney Transplantation
Male
Middle Aged
Morbidity
Plasmapheresis
Retrospective Studies
Rituximab
Survival Rate
Treatment Outcome
Wisconsin