Robert R Redfield1, Thomas M Ellis2, Weixiong Zhong3, Joseph R Scalea4, Tiffany J Zens5, Didier Mandelbrot6, Brenda L Muth6, Sarah Panzer6, Millie Samaniego7, Dixon B Kaufman4, Brad C Astor8, Arjang Djamali9. 1. Division of Transplantation, Department of Surgery, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States. Electronic address: rrredfield@wisc.edu. 2. HLA Laboratory, Department of Pathology, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States. 3. Department of Pathology, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States. 4. Division of Transplantation, Department of Surgery, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States. 5. Department of Surgery, University of Wisconsin - Madison School of Medicine an and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States. 6. Division of Nephrology, Department of Medicine, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States. 7. Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, United States. 8. Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States. 9. Division of Transplantation, Department of Surgery, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States; Division of Nephrology, Department of Medicine, University of Wisconsin - Madison School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, Madison, WI 53792, United States.
Abstract
BACKGROUND: The updated BANFF 2013 criteria has enabled a more standardized and complete serologic and histopathologic diagnosis of chronic active antibody mediated rejection (cAMR). Little data exists on the outcomes of cAMR since the initiation of this updated criteria. METHODS: 123 consecutive patients with biopsy proven cAMR (BANFF 2013) between 2006 and 2012 were identified. RESULTS: Patients identified with cAMR were followed for a median of 9.5 (2.7-20.3) years after transplant and 4.3 (0-8.8) years after cAMR. Ninety-four (76%) recipients lost their grafts with a median survival of 1.9 years after diagnosis with cAMR. Mean C4d and allograft glomerulopathy scores were 2.6 ± 0.7 and 2.2 ± 0.8, respectively. 53.2% had class II DSA, 32.2% had both class I and II, and 14.5% had class I DSA only. Chronicity score >8 (HR 2.9, 95% CI 1-8.4, p=0.05), DSA >2500 MFI (HR 2.8, 95% CI 1.1-6.8, p=0.03), Scr >3mg/dL (HR 3.2, 95% CI 1.6-6.3, p=0.001) and UPC >1g/g (HR 2.5, 95% CI 1.4-4.5, p=0.003) were associated with a higher risk of graft loss. CONCLUSIONS: cAMR was associated with poor graft survival after diagnosis. Improved therapies and earlier detection strategies are likely needed to improve outcomes of cAMR in kidney transplant recipients.
BACKGROUND: The updated BANFF 2013 criteria has enabled a more standardized and complete serologic and histopathologic diagnosis of chronic active antibody mediated rejection (cAMR). Little data exists on the outcomes of cAMR since the initiation of this updated criteria. METHODS: 123 consecutive patients with biopsy proven cAMR (BANFF 2013) between 2006 and 2012 were identified. RESULTS:Patients identified with cAMR were followed for a median of 9.5 (2.7-20.3) years after transplant and 4.3 (0-8.8) years after cAMR. Ninety-four (76%) recipients lost their grafts with a median survival of 1.9 years after diagnosis with cAMR. Mean C4d and allograft glomerulopathy scores were 2.6 ± 0.7 and 2.2 ± 0.8, respectively. 53.2% had class II DSA, 32.2% had both class I and II, and 14.5% had class I DSA only. Chronicity score >8 (HR 2.9, 95% CI 1-8.4, p=0.05), DSA >2500 MFI (HR 2.8, 95% CI 1.1-6.8, p=0.03), Scr >3mg/dL (HR 3.2, 95% CI 1.6-6.3, p=0.001) and UPC >1g/g (HR 2.5, 95% CI 1.4-4.5, p=0.003) were associated with a higher risk of graft loss. CONCLUSIONS: cAMR was associated with poor graft survival after diagnosis. Improved therapies and earlier detection strategies are likely needed to improve outcomes of cAMR in kidney transplant recipients.
Authors: Nancy A Wilson; James Dylewski; Kenna R Degner; Megan A O'Neill; Shannon R Reese; Luis G Hidalgo; Judith Blaine; Sarah E Panzer Journal: Transpl Immunol Date: 2019-12-27 Impact factor: 1.708
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Authors: Kenna R Degner; Nancy A Wilson; Shannon R Reese; Sandesh Parajuli; Fahad Aziz; Neetika Garg; Maha Mohamed; Tripti Singh; Didier A Mandelbrot; Sarah E Panzer; Robert R Redfield; Kristin Van Hyfte; Weixiong Zhong; Luis G Hidalgo; Arjang Djamali Journal: Kidney360 Date: 2020-05-28
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