title: Antibody-mediated rejection of the kidney after simultaneous pancreas-kidney transplantation.
abstract: The prevalence, risk factors, and outcome of antibody-mediated rejection (AMR) of the kidney after simultaneous pancreas-kidney transplantation are unknown. In 136 simultaneous pancreas-kidney recipients who were followed for an average of 3.1 yr, 21 episodes of AMR of the kidney allograft were identified. Eight episodes occurred early (</=90 d) after transplantation, and 13 occurred later. Histologic evidence of concomitant acute cellular rejection was noted in 12 cases; the other nine had evidence only of humoral rejection. In 13 cases, clinical rejection of the pancreas was diagnosed simultaneously, and two of these were biopsy proven and were positive for C4d immunostaining. Multivariate analysis identified only one significant risk factor: Female patients were three times more likely to experience AMR. Nearly all early episodes resolved with treatment and did not predict graft loss, but multivariate Cox models revealed that late AMR episodes more than tripled the risk for kidney and pancreas graft loss; therefore, new strategies are needed to prevent and to treat late AMR in simultaneous pancreas-kidney transplant recipients.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Wisconsin Hospital and Clinics, H4/772 CSC, 600 Highland Avenue, Madison, WI 53792-7375, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.forename: Milagros D
authors.initials: MD
authors.lastname: Samaniego
authors.forename: José R
authors.initials: JR
authors.lastname: Torrealba
authors.forename: Jon S
authors.initials: JS
authors.lastname: Odorico
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
authors.forename: Yolanda T
authors.initials: YT
authors.lastname: Becker
authors.forename: Barbara
authors.initials: B
authors.lastname: Voss
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: Hans W
authors.initials: HW
authors.lastname: Sollinger
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
mesh_terms: D000328:Adult; D000906:Antibodies / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods; D008297:Male; D016035:Pancreas Transplantation / Q000379:methods
chemical_list: D000906:Antibodies