Acute antibody-mediated rejection in living ABO-incompatible kidney transplantation: long-term impact and risk factors.
The impact of acute antibody-mediated rejection (AAMR) on the long-term outcome on ABO-incompatible (ABOI) kidney transplantation is not well understood. We retrospectively analyzed the long-term impact of AAMR and risk factors for AAMR in 57 consecutive recipients performed between 1999 and 2004. Nineteen patients (33%) who developed AAMR within 3 months posttransplantation constituted of the AMR group. The graft survival rate was significantly lower in the AMR group (AMR vs. non-AMR, respectively; 5 years: 84% vs. 95%; 8 years: 45% vs. 95%; p = 0.009). The prevalence of transplant glomerulopathy at 1 year posttransplantation was significantly higher in the AMR group (AMR 64% vs. non-AMR 3%, p < 0.001). Multivariate analysis demonstrated that anti-blood group IgG antibody titers of 1:32 at the time of transplantation (OR, 9.52; p = 0.041) and donor-specific anti-HLA antibodies (DSHA) detected by Luminex single bead method (OR, 5.68; p = 0.015) were independent risk factors for AAMR regardless of baseline anti-blood group IgG antibody titers. Our results indicate that AAMR has a heavy impact on the long-term outcome and preoperative DSHA appears to have a more significant association with poor graft outcomes than anti-blood group antibodies, even in ABOI kidney transplantation.
Toki
D
D
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan. tokidsk@gmail.com
Ishida
H
H
Setoguchi
K
K
Shimizu
T
T
Omoto
K
K
Shirakawa
H
H
Iida
S
S
Horita
S
S
Furusawa
M
M
Ishizuka
T
T
Yamaguchi
Y
Y
Tanabe
K
K
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000906:Antibodies / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D003401:Creatine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D012307:Risk Factors
D000017:ABO Blood-Group System; D000906:Antibodies; D003401:Creatine