Outcome of subclinical antibody-mediated rejection in kidney transplant recipients with preformed donor-specific antibodies.
This study describes clinical relevance of subclinical antibody-mediated rejection (SAMR) in a cohort of 54 DSA-positive kidney transplant recipients receiving a deceased donor. In 3 months screening biopsies, 31.1% of patients met the criteria of SAMR. A total of 48.9% had an incomplete form of SAMR (g+/ptc+/C4d-negative) whereas 20% had no humoral lesions. Patients with SAMR at 3 months had at 1 year: a higher C4d score, ptc score, and arteriosclerosis score, higher rate of IFTA (100% vs. 33.3%, p < 0.01) and a higher rate of transplant glomerulopathy (43% vs. 0%, p = 0.02) compared to patients without 3-month SAMR. Patients with SAMR at 3 months exhibited at 1 year a higher class II MFImax-DSA and a lower mGFR compared to patients without SAMR (39.2 +/- 13.9 vs. 61.9 +/- 19.2 mL/min/1.73 m(2) respectively, p < 0.01). The group of patients with C4d-negative SAMR at 3 months developed more ptc and IFTA lesions, and lower GFR at 1 year in comparison to biopsies without humoral lesions. SAMR is a frequent entity in KTR with preexisting DSAs and promotes subsequent GFR impairment and development of chronic AMR. C4d-negative SAMR patients displayed an intermediate course between the no-SAMR group and the C4d+ SAMR group. Screening biopsies may be useful to recognize patients more likely to develop SAMR.
INSERM UMR 872, Université Paris Descartes, Paris, France. alexandreloupy@gmail.com
A
A
Loupy
C
C
Suberbielle-Boissel
G S
GS
Hill
C
C
Lefaucheur
D
D
Anglicheau
J
J
Zuber
F
F
Martinez
E
E
Thervet
A
A
Méjean
D
D
Charron
J P
JP
Duong van Huyen
P
P
Bruneval
C
C
Legendre
D
D
Nochy
D000208:Acute Disease; D000328:Adult; D000918:Antibody Specificity; D001706:Biopsy; D015935:Complement C4b / Q000276:immunology; D005919:Glomerular Filtration Rate / Q000276:immunology; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000276:immunology* / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D008875:Middle Aged; D010446:Peptide Fragments / Q000276:immunology; D011507:Proteinuria / Q000276:immunology / Q000401:mortality / Q000473:pathology; D012307:Risk Factors; D014019:Tissue Donors
D006680:HLA Antigens; D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d