Antibody-mediated rejection implies a poor prognosis in kidney transplantation: Results from a single center

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Abstract

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 DSAs/non-DSAs 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.

Original languageEnglish (US)
JournalClinical Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

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Kidney Transplantation
Antibodies
Graft Survival
Transplants
Rejection (Psychology)
Patient Compliance
Immunosuppression
Adrenal Cortex Hormones
Kidney

Keywords

  • antibody-mediated rejection component
  • death-censored graft survival following rejection
  • renal transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{d32f0860e29c4be0bba3ff108c6952d9,
title = "Antibody-mediated rejection implies a poor prognosis in kidney transplantation: Results from a single center",
abstract = "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 DSAs/non-DSAs 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.",
keywords = "antibody-mediated rejection component, death-censored graft survival following rejection, renal transplantation",
author = "Gaetano Ciancio and Jeffrey Gaynor and Giselle Guerra and Junichiro Sageshima and David Roth and Chen, {Linda J} and Warren Kupin and Mattiazzi, {Adela D} and Lissett Tueros and Phillip Ruiz and Rodrigo Vianna and Burke, {George W}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/ctr.13392",
language = "English (US)",
journal = "Clinical Transplantation",
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TY - JOUR

T1 - Antibody-mediated rejection implies a poor prognosis in kidney transplantation

T2 - Results from a single center

AU - Ciancio, Gaetano

AU - Gaynor, Jeffrey

AU - Guerra, Giselle

AU - Sageshima, Junichiro

AU - Roth, David

AU - Chen, Linda J

AU - Kupin, Warren

AU - Mattiazzi, Adela D

AU - Tueros, Lissett

AU - Ruiz, Phillip

AU - Vianna, Rodrigo

AU - Burke, George W

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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 DSAs/non-DSAs 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.

AB - 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 DSAs/non-DSAs 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.

KW - antibody-mediated rejection component

KW - death-censored graft survival following rejection

KW - renal transplantation

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U2 - 10.1111/ctr.13392

DO - 10.1111/ctr.13392

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JF - Clinical Transplantation

SN - 0902-0063

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