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Quantifying renal allograft loss following early antibody-mediated rejection.

Publication ,  Journal Article
Orandi, BJ; Chow, EHK; Hsu, A; Gupta, N; Van Arendonk, KJ; Garonzik-Wang, JM; Montgomery, JR; Wickliffe, C; Lonze, BE; Bagnasco, SM; Kraus, ES ...
Published in: Am J Transplant
February 2015

Unlike antibody-mediated rejection (AMR) with clinical features, it remains unclear whether subclinical AMR should be treated, as its effect on allograft loss is unknown. It is also uncertain if AMR's effect is homogeneous across donor (deceased/live) and (HLA/ABO) antibody types. We compared 219 patients with AMR (77 subclinical, 142 clinical) to controls matched on HLA/ABO-compatibility, donor type, prior transplant, panel reactive antibody (PRA), age and year. One and 5-year graft survival in subclinical AMR was 95.9% and 75.7%, compared to 96.8% and 88.4% in matched controls (p = 0.0097). Subclinical AMR was independently associated with a 2.15-fold increased risk of graft loss (95% CI: 1.19-3.91; p = 0.012) compared to matched controls, but not different from clinical AMR (p = 0.13). Fifty three point two percent of subclinical AMR patients were treated with plasmapheresis within 3 days of their AMR-defining biopsy. Treated subclinical AMR patients had no difference in graft loss compared to matched controls (HR 1.73; 95% CI: 0.73-4.05; p = 0.21), but untreated subclinical AMR patients did (HR 3.34; 95% CI: 1.37-8.11; p = 0.008). AMR's effect on graft loss was heterogeneous when stratified by compatible deceased donor (HR = 4.73; 95% CI: 1.57-14.26; p = 0.006), HLA-incompatible deceased donor (HR = 2.39; 95% CI: 1.10-5.19; p = 0.028), compatible live donor (no AMR patients experienced graft loss), ABO-incompatible live donor (HR = 6.13; 95% CI: 0.55-67.70; p = 0.14) and HLA-incompatible live donor (HR = 6.29; 95% CI: 3.81-10.39; p < 0.001) transplant. Subclinical AMR substantially increases graft loss, and treatment seems warranted.

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Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

February 2015

Volume

15

Issue

2

Start / End Page

489 / 498

Location

United States

Related Subject Headings

  • Time Factors
  • Surgery
  • Risk Factors
  • Middle Aged
  • Male
  • Living Donors
  • Kidney Transplantation
  • Kidney
  • Incidence
  • Humans
 

Citation

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Orandi, B. J., Chow, E. H. K., Hsu, A., Gupta, N., Van Arendonk, K. J., Garonzik-Wang, J. M., … Segev, D. L. (2015). Quantifying renal allograft loss following early antibody-mediated rejection. Am J Transplant, 15(2), 489–498. https://doi.org/10.1111/ajt.12982
Orandi, B. J., E. H. K. Chow, A. Hsu, N. Gupta, K. J. Van Arendonk, J. M. Garonzik-Wang, J. R. Montgomery, et al. “Quantifying renal allograft loss following early antibody-mediated rejection.Am J Transplant 15, no. 2 (February 2015): 489–98. https://doi.org/10.1111/ajt.12982.
Orandi BJ, Chow EHK, Hsu A, Gupta N, Van Arendonk KJ, Garonzik-Wang JM, et al. Quantifying renal allograft loss following early antibody-mediated rejection. Am J Transplant. 2015 Feb;15(2):489–98.
Orandi, B. J., et al. “Quantifying renal allograft loss following early antibody-mediated rejection.Am J Transplant, vol. 15, no. 2, Feb. 2015, pp. 489–98. Pubmed, doi:10.1111/ajt.12982.
Orandi BJ, Chow EHK, Hsu A, Gupta N, Van Arendonk KJ, Garonzik-Wang JM, Montgomery JR, Wickliffe C, Lonze BE, Bagnasco SM, Alachkar N, Kraus ES, Jackson AM, Montgomery RA, Segev DL. Quantifying renal allograft loss following early antibody-mediated rejection. Am J Transplant. 2015 Feb;15(2):489–498.
Journal cover image

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

February 2015

Volume

15

Issue

2

Start / End Page

489 / 498

Location

United States

Related Subject Headings

  • Time Factors
  • Surgery
  • Risk Factors
  • Middle Aged
  • Male
  • Living Donors
  • Kidney Transplantation
  • Kidney
  • Incidence
  • Humans