Mid-Term Outcomes After Treatment for Antibody-Mediated Rejection by De Novo Donor-Specific HLA Antibody in Renal Transplant Recipients: Does Early Treatment Lead to Better Outcomes?

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  • Additional Information
    • Source:
      Publisher: Elsevier Science Inc Country of Publication: United States NLM ID: 0243532 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2623 (Electronic) Linking ISSN: 00411345 NLM ISO Abbreviation: Transplant Proc Subsets: MEDLINE
    • Publication Information:
      Publication: New York, N.Y. : Elsevier Science Inc.
      Original Publication: New York Stratton.
    • Subject Terms:
      Kidney Transplantation*/mortality; Graft Rejection/*therapy ; Immunologic Factors/*therapeutic use ; Plasmapheresis/*methods ; Rituximab/*therapeutic use; Adult ; Antibodies/immunology ; Female ; Graft Rejection/immunology ; Graft Survival/immunology ; HLA Antigens/immunology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Tissue Donors ; Transplant Recipients ; Transplantation, Homologous ; Young Adult
    • Abstract:
      Background: De novo donor-specific HLA antibody (DSA) and antibody-mediated rejection (ABMR) are strongly associated with late allograft loss in renal transplant recipients. However, the impact of therapeutic intervention with the current treatment options for ABMR remains unclear. This study aimed to elucidate the efficacy of treatment for ABMR.
      Methods: Sixty-seven patients who had de novo DSAs underwent diagnostic biopsy for ABMR, and these patients were classified into 3 groups: ABMR-free group (n = 40), clinical ABMR group (n = 15), and subclinical ABMR group (n = 12). The ABMR-positive groups were treated mainly with double-filtration plasmapheresis followed by rituximab and corticosteroid pulse. The patient characteristics and graft outcomes were compared between groups.
      Results: The clinical and subclinical ABMR groups were younger and had a higher number and mean fluorescence intensity (MFI) of de novo DSAs than the ABMR-free group. The graft survival in the clinical ABMR group was significantly lower than that in the ABMR-free group, but the subclinical ABMR group had a surprisingly good graft survival rate compared to the ABMR-free group (43.3% vs 100% vs 94.2% 5 years after diagnostic biopsy in the clinical ABMR, subclinical ABMR, and ABMR-free groups, respectively, P < .001).
      Conclusions: Our findings indicated that early therapeutic intervention for patients with de novo DSAs may improve graft survival.
      (Copyright © 2020 Elsevier Inc. All rights reserved.)
    • Accession Number:
      0 (Antibodies)
      0 (HLA Antigens)
      0 (Immunologic Factors)
      4F4X42SYQ6 (Rituximab)
    • Publication Date:
      Date Created: 20200723 Date Completed: 20210215 Latest Revision: 20210215
    • Publication Date:
      20231215
    • Accession Number:
      10.1016/j.transproceed.2020.06.022
    • Accession Number:
      32694058