BACKGROUND: Identification of risk factors for renal allograft failure after an episode of acute antibody-mediated rejection (AMR) may help the outcome of this difficult-to-treat complication. METHODS: During December 2003 to February 2011, 833 kidney graft recipients underwent 1120 clinically indicated biopsies at our center. We reviewed the biopsy results and identified 87 biopsy specimens from 87 patients positive for the degradation product of complement component 4 (C4d) and acute AMR. We generated Kaplan-Meier survival curves and performed a multivariable analysis using the Cox proportional hazards regression model to identify risk factors for allograft failure after C4d+ acute AMR. RESULTS: Among the 87 patients, 26 had a diagnosis of acute AMR according to the Banff '09 classification schema, 29 had acute AMR and chronic active AMR, 18 had acute AMR and acute T-cell mediated rejection (TCMR), and 14 had acute AMR, chronic active AMR, and acute TCMR. Kaplan-Meier survival estimates showed that concurrent acute TCMR (P=0.001, Mantel-Cox log-rank test), concurrent chronic active AMR (P=0.03), and time to biopsy (P=0.04) are associated with graft survival. The Cox proportional hazards regression analysis identified that concurrent acute TCMR (hazard ratio, 2.59 [95% confidence interval, 1.21-5.55]; P=0.01) and estimated glomerular filtration rate (hazard ratio, 0.65 [95% confidence interval, 0.48-0.88]; P=0.01) are independent risk factors for allograft loss. Concurrent chronic active AMR or time to biopsy was not associated with graft failure by the multivariable Cox analysis. CONCLUSIONS: Our single-center study has elucidated that concurrent acute TCMR in kidney transplant recipients with C4d+ acute AMR is an independent risk factor for graft failure. Level of allograft function at the time of diagnosis was also an independent predictor of graft loss.
BACKGROUND: Identification of risk factors for renal allograft failure after an episode of acute antibody-mediated rejection (AMR) may help the outcome of this difficult-to-treat complication. METHODS: During December 2003 to February 2011, 833 kidney graft recipients underwent 1120 clinically indicated biopsies at our center. We reviewed the biopsy results and identified 87 biopsy specimens from 87 patients positive for the degradation product of complement component 4 (C4d) and acute AMR. We generated Kaplan-Meier survival curves and performed a multivariable analysis using the Cox proportional hazards regression model to identify risk factors for allograft failure after C4d+ acute AMR. RESULTS: Among the 87 patients, 26 had a diagnosis of acute AMR according to the Banff '09 classification schema, 29 had acute AMR and chronic active AMR, 18 had acute AMR and acute T-cell mediated rejection (TCMR), and 14 had acute AMR, chronic active AMR, and acute TCMR. Kaplan-Meier survival estimates showed that concurrent acute TCMR (P=0.001, Mantel-Cox log-rank test), concurrent chronic active AMR (P=0.03), and time to biopsy (P=0.04) are associated with graft survival. The Cox proportional hazards regression analysis identified that concurrent acute TCMR (hazard ratio, 2.59 [95% confidence interval, 1.21-5.55]; P=0.01) and estimated glomerular filtration rate (hazard ratio, 0.65 [95% confidence interval, 0.48-0.88]; P=0.01) are independent risk factors for allograft loss. Concurrent chronic active AMR or time to biopsy was not associated with graft failure by the multivariable Cox analysis. CONCLUSIONS: Our single-center study has elucidated that concurrent acute TCMR in kidney transplant recipients with C4d+ acute AMR is an independent risk factor for graft failure. Level of allograft function at the time of diagnosis was also an independent predictor of graft loss.
Authors: H E Feucht; E Felber; M J Gokel; G Hillebrand; U Nattermann; C Brockmeyer; E Held; G Riethmüller; W Land; E Albert Journal: Clin Exp Immunol Date: 1991-12 Impact factor: 4.330
Authors: H E Feucht; H Schneeberger; G Hillebrand; K Burkhardt; M Weiss; G Riethmüller; W Land; E Albert Journal: Kidney Int Date: 1993-06 Impact factor: 10.612
Authors: B J Nankivell; C A Fenton-Lee; D R Kuypers; E Cheung; R D Allen; P J O'Connell; J R Chapman Journal: Transplantation Date: 2001-02-27 Impact factor: 4.939
Authors: C Lefaucheur; D Nochy; G S Hill; C Suberbielle-Boissel; C Antoine; D Charron; D Glotz Journal: Am J Transplant Date: 2007-04 Impact factor: 8.086
Authors: Matthew J Everly; Jason J Everly; Brian Susskind; Paul Brailey; Lois J Arend; Rita R Alloway; Prabir Roy-Chaudhury; Amit Govil; Gautham Mogilishetty; Adele H Rike; Michael Cardi; George Wadih; Amit Tevar; E Steve Woodle Journal: Transplantation Date: 2008-12-27 Impact factor: 4.939
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Thangamani Muthukumar; John R Lee; Darshana M Dadhania; Ruchuang Ding; Vijay K Sharma; Joseph E Schwartz; Manikkam Suthanthiran Journal: Transplant Rev (Orlando) Date: 2014-05-27 Impact factor: 3.943
Authors: Erik Stites; Dhiren Kumar; Oyedolamu Olaitan; Sidney John Swanson; Nicolae Leca; Matthew Weir; Jonathan Bromberg; Joseph Melancon; Irfan Agha; Hasan Fattah; Tarek Alhamad; Yasir Qazi; Alexander Wiseman; Gaurav Gupta Journal: Am J Transplant Date: 2020-03-10 Impact factor: 8.086
Authors: Marius Andreas Koslik; Justa Friebus-Kardash; Falko Markus Heinemann; Andreas Kribben; Jan Hinrich Bräsen; Ute Eisenberger Journal: Front Med (Lausanne) Date: 2022-01-31
Authors: Carrie A Schinstock; Roslyn B Mannon; Klemens Budde; Anita S Chong; Mark Haas; Stuart Knechtle; Carmen Lefaucheur; Robert A Montgomery; Peter Nickerson; Stefan G Tullius; Curie Ahn; Medhat Askar; Marta Crespo; Steven J Chadban; Sandy Feng; Stanley C Jordan; Kwan Man; Michael Mengel; Randall E Morris; Inish O'Doherty; Binnaz H Ozdemir; Daniel Seron; Anat R Tambur; Kazunari Tanabe; Jean-Luc Taupin; Philip J O'Connell Journal: Transplantation Date: 2020-05 Impact factor: 5.385