BACKGROUND: Classification of acute rejection (AR) based on etiology and timing may provide a means for enhancing therapeutic results and allograft survival. This study evaluated graft and patient survival after the first AR episodes among kidney transplant recipients with an early or late antibody-mediated rejection (AMR), acute cellular rejection (ACR) or mixed AR (MAR). METHODS: A prospective institutional review board-approved database was queried to identify biopsy-proven first AR episodes occurring from January 2005 to October 2012. The ACR was defined by Banff criteria; borderline AR was excluded. The AMR was defined as 3 of 4 criteria: renal dysfunction, donor specific antibody, C4d positivity on biopsy, and histological changes. The MAR met criteria for both ACR and AMR. Early AR occurred within six months post-transplant. AR episodes were then assigned to 1 of the 6 categories--early AMR, early ACR, early MAR, late AMR, late ACR, and late MAR. RESULTS: One hundred eighty-two kidney transplant recipients identified with a first AR episode. Mean follow-up was 773 days (± 715 days). No difference was observed in patient survival. Death-censored graft survival was 84%. Death-censored graft loss was higher with late versus early AMR (P = 0.01) and late versus early ACR (P = 0.03), but not late versus early MAR (P = 0.3). CONCLUSIONS: The AR type demonstrated a hierarchy for graft survival with ACR better than MAR better than AMR, which persisted for both early and late AR. Improvement in long-term results of AR may require development of specific treatment for individual AR types.
BACKGROUND: Classification of acute rejection (AR) based on etiology and timing may provide a means for enhancing therapeutic results and allograft survival. This study evaluated graft and patient survival after the first AR episodes among kidney transplant recipients with an early or late antibody-mediated rejection (AMR), acute cellular rejection (ACR) or mixed AR (MAR). METHODS: A prospective institutional review board-approved database was queried to identify biopsy-proven first AR episodes occurring from January 2005 to October 2012. The ACR was defined by Banff criteria; borderline AR was excluded. The AMR was defined as 3 of 4 criteria: renal dysfunction, donor specific antibody, C4d positivity on biopsy, and histological changes. The MAR met criteria for both ACR and AMR. Early AR occurred within six months post-transplant. AR episodes were then assigned to 1 of the 6 categories--early AMR, early ACR, early MAR, late AMR, late ACR, and late MAR. RESULTS: One hundred eighty-two kidney transplant recipients identified with a first AR episode. Mean follow-up was 773 days (± 715 days). No difference was observed in patient survival. Death-censored graft survival was 84%. Death-censored graft loss was higher with late versus early AMR (P = 0.01) and late versus early ACR (P = 0.03), but not late versus early MAR (P = 0.3). CONCLUSIONS: The AR type demonstrated a hierarchy for graft survival with ACR better than MAR better than AMR, which persisted for both early and late AR. Improvement in long-term results of AR may require development of specific treatment for individual AR types.
Authors: Marieke van der Zwan; Marian C Clahsen-Van Groningen; Joke I Roodnat; Anne P Bouvy; Casper L Slachmuylders; Willem Weimar; Carla C Baan; Dennis A Hesselink; Marcia M L Kho Journal: Ann Transplant Date: 2018-08-17 Impact factor: 1.530
Authors: Camila Macedo; Kevin Hadi; John Walters; Beth Elinoff; Marilyn Marrari; Adriana Zeevi; Bala Ramaswami; Geetha Chalasani; Douglas Landsittel; Adele Shields; Rita Alloway; Fadi G Lakkis; E Steve Woodle; Diana Metes Journal: Kidney Int Rep Date: 2018-12-08
Authors: Audrey Uffing; Luis G Hidalgo; Ciaran McMullan; Jacqueline Perry; Edgar L Milford; Naoka Murakami; Melissa Y Yeung; Indira Guleria; Isabelle G Wood; Enver Akalin; Jamil Azzi; Anil K Chandraker; Leonardo V Riella Journal: Transplant Direct Date: 2019-04-15
Authors: Dixon B Kaufman; E Steve Woodle; Adele Rike Shields; John Leone; Arthur Matas; Alexander Wiseman; Patricia West-Thielke; Ting Sa; Eileen C King; Rita R Alloway Journal: Clin J Am Soc Nephrol Date: 2021-07-07 Impact factor: 10.614
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