The effect of histopathologic and clinical features on allograft survival in renal transplant patients with antibody-mediated rejection

Background: Antibody-mediated rejection is a frequent cause of graft failure; however, prognostic indications of this complication have not been well defined. The aim of this study was to evaluate the association of histopathological and clinical features and to determine the effect of these finding...

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Bibliographic Details
Published in:Renal failure 2017-11, Vol.39 (1), p.19-25
Main Authors: Akagun, Tulin, Yazici, Halil, Caliskan, Yasar, Ozluk, Yasemin, Sahin, Sevgi, Turkmen, Aydin, Kılıcaslan, Isın, Sever, Mehmet Sukru
Format: Article
Language:English
Subjects:
Adult
allograft survival
Antibodies - blood
antibody-mediated rejection
Arteritis
Biopsy
Clinical Study
Complement C4b - immunology
Creatinine
Creatinine - blood
Female
Graft rejection
Graft Rejection - epidemiology
Graft Survival
Grafts
Humans
Kaplan-Meier Estimate
Kidney Transplantation
Male
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Renal transplantation
Retrospective Studies
serum creatinine
Survival
transplant biopsy
Transplantation, Homologous
Transplants & implants
Turkey
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Summary:Background: Antibody-mediated rejection is a frequent cause of graft failure; however, prognostic indications of this complication have not been well defined. The aim of this study was to evaluate the association of histopathological and clinical features and to determine the effect of these findings on allograft survival in patients with AMR. Methods: Fifty-two patients suffered from AMR (30 male; mean age 39 ± 11 years) were included in the study. Data were investigated retrospectively and graft survival was analyzed. All transplant biopsies were evaluated according to Banff 2009 classification. Results: Of the 52 cases, 45 were transplanted from living-donors. Twenty-one patients were diagnosed in the first 3-months after transplantation. Graft survival was 65% at 12 months and 54% at 36 months. Mean serum creatinine at time of biopsy was 3.8 ± 3.6 mg/dL. Thirty-five of the 52 cases showed diffuse C4d positivity, 12 cases showed focal and 5 remained C4d negative. One of the patients died, 13 experienced graft loss and 38 survived with functioning grafts. Serum creatinine levels at time of biopsy were correlated with graft survival (p = .021: OR = 1.10: 95 % CI = 1.015-1.199). In terms of the impact of pathological findings; tubulitis (p=.007: OR = 2.62: 95 % CI = 1.301-5.276), intimal arteritis (p=.017: OR = 2.85: 95% CI = 1.205-6.744) and interstitial infiltration (p=.004: OR = 3.37: 95% CI = 1.465-7.752) were associated with graft survival. Conclusions: Serum creatinine at time of biopsy, tubulitis, intimal arteritis and interstitial infiltration were significantly associated with graft survival. Antibody-mediated rejection is associated with reduced long-term graft survival.
ISSN:0886-022X
1525-6049
DOI:10.1080/0886022X.2016.1244073