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Antibody‐mediated rejection implies a poor prognosis in kidney transplantation: Results from a single center
Author(s) -
Ciancio Gaetano,
Gaynor Jeffrey J.,
Guerra Giselle,
Sageshima Junichiro,
Roth David,
Chen Linda,
Kupin Warren,
Mattiazzi Adela,
Tueros Lissett,
Ruiz Phillip,
Vianna Rodrigo,
Burke George W.
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13392
Subject(s) - medicine , daclizumab , immunosuppression , alemtuzumab , hazard ratio , kidney transplantation , single center , transplantation , surgery , urology , tacrolimus , confidence interval
Two major barriers to achieving long‐term graft survival include patient nonadherence in taking the prescribed immunosuppression and antibody‐mediated rejection( AMR ). We were therefore interested in determining the prognostic impact of developing an AMR component to rejection in a prospective randomized trial of 200 kidney transplant recipients who received dual induction therapy ( rATG combined with either daclizumab or alemtuzumab) and planned early corticosteroid withdrawal. With a median follow‐up of 96 months post‐transplant, 40/200 developed a first BPAR ; 9/200 developed a second BPAR . An AMR component to rejection was observed in 70% (28/40) of cases. Percentages having C4d deposition, histopathologic evidence of acute AMR , and presence of DSA s/non‐ DSA s at the time of first developing the AMR component were 64.3% (18/28), 60.7% (17/28), and 53.6% (15/28), respectively. Development of an AMR component was associated with a significantly higher death‐censored graft failure rate following rejection in comparison with the patient state of experiencing BPAR but without developing an AMR component (estimated hazard ratio: 4.52, P = 0.01). The observed percentage developing graft failure following development of an AMR component was 53.6% (15/28) vs only 20.0%(3/15) if it was not observed. Actuarial death‐censored graft survival at 60 months following development of an AMR component was 28.3 ± 11.9%. In summary, it appears that more effective AMR prevention/treatment strategies are warranted.