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Outcome of Subclinical Antibody‐Mediated Rejection in Kidney Transplant Recipients with Preformed Donor‐Specific Antibodies
Author(s) -
Loupy A.,
SuberbielleBoissel C.,
Hill G. S.,
Lefaucheur C.,
Anglicheau D.,
Zuber J.,
Martinez F.,
Thervet E.,
Méjean A.,
Charron D.,
Duong van Huyen J. P.,
Bruneval P.,
Legendre C.,
Nochy D.
Publication year - 2009
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2009.02813.x
Subject(s) - medicine , subclinical infection , glomerulopathy , antibody , kidney , gastroenterology , kidney transplantation , renal function , kidney disease , cohort , urology , immunology , proteinuria
This study describes clinical relevance of subclinical antibody‐mediated rejection (SAMR) in a cohort of 54 DSA‐positive kidney transplant recipients receiving a deceased donor. In 3 months screening biopsies, 31.1% of patients met the criteria of SAMR. A total of 48.9% had an incomplete form of SAMR (g+/ptc+/C4d‐negative) whereas 20% had no humoral lesions. Patients with SAMR at 3 months had at 1 year: a higher C4d score, ptc score, and arteriosclerosis score, higher rate of IFTA (100% vs. 33.3%, p < 0.01) and a higher rate of transplant glomerulopathy (43% vs. 0%, p = 0.02) compared to patients without 3‐month SAMR. Patients with SAMR at 3 months exhibited at 1 year a higher class II MFImax‐DSA and a lower mGFR compared to patients without SAMR (39.2 ± 13.9 vs. 61.9 ± 19.2 mL/min/1.73 m 2 respectively, p < 0.01). The group of patients with C4d‐negative SAMR at 3 months developed more ptc and IFTA lesions, and lower GFR at 1 year in comparison to biopsies without humoral lesions. SAMR is a frequent entity in KTR with preexisting DSAs and promotes subsequent GFR impairment and development of chronic AMR. C4d‐negative SAMR patients displayed an intermediate course between the no‐SAMR group and the C4d+ SAMR group. Screening biopsies may be useful to recognize patients more likely to develop SAMR.