Current outcomes of chronic active antibody mediated rejection – A large single center retrospective review using the updated BANFF 2013 criteria

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 consecu...

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Published in:Human immunology 2016-04, Vol.77 (4), p.346-352
Main Authors: Redfield, Robert R, Ellis, Thomas M, Zhong, Weixiong, Scalea, Joseph R, Zens, Tiffany J, Mandelbrot, Didier, Muth, Brenda L, Panzer, Sarah, Samaniego, Millie, Kaufman, Dixon B, Astor, Brad C, Djamali, Arjang
Format: Article
Language:English
Subjects:
Allergy and Immunology
Antibody-Dependent Cell Cytotoxicity
Biopsy
Chronic Allograft Rejection
Follow-Up Studies
Graft Rejection - immunology
Graft Rejection - pathology
Graft Survival - immunology
Humans
Isoantibodies - immunology
Kidney Transplantation
Outcomes
Patient Outcome Assessment
Renal transplantation
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Summary: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 >3 mg/dL (HR 3.2, 95% CI 1.6–6.3, p = 0.001) and UPC >1 g/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.
ISSN:0198-8859
1879-1166
DOI:10.1016/j.humimm.2016.01.018