title: Late acute humoral rejection in low-risk renal transplant recipients induced with an interleukin-2 receptor antagonist and maintained with standard therapy: preliminary communication.
abstract: Low-risk renal transplant recipients treated with standard immunosuppressive therapy including interleukin-2 receptor (IL-2R) antagonist show a low incidence of early rejection episodes but few reports have examined the incidence and severity of late rejection processes. This study evaluated retrospectively cellular and antibody-mediated rejection (AMR) among 42 recipients selected because they showed low panel-reactive-antibodies, short cold ischemia time, no delayed graft function, and therapy including basiliximab (Simulect) induction. The mean observation time was 6.6 years. Sixty-seven percent of donors were deceased. Ten-year patient and death-censored graft survivals were 81% and 78%, respectively. Seven patients lost their kidneys due to nonimmunologic events. The seven recipients who experienced cellular rejection episodes during the first posttransplant year had them reversed with steroids. Five patients displayed late acute AMR causing functional deterioration in four cases including 1 graft loss. De novo sensitization occurred in 48% of recipients including patients without clinical rejection. In conclusion, long-term follow-up of kidney transplant recipients selected by a low immunologic risk showed a persistent risk of de novo sensitization evolving to acute AMR in 11% of cases. Although immunologic events were related to late immunosuppressive reduction, most graft losses were due to nonimmunologic factors.
authors.affiliation: Centro de Transplante, Clínica Las Condes, Santiago, Chile. imorales@clc.cl
authors.forename: J
authors.initials: J
authors.lastname: Morales
authors.forename: L
authors.initials: L
authors.lastname: Contreras
authors.forename: C
authors.initials: C
authors.lastname: Zehnder
authors.forename: V
authors.initials: V
authors.lastname: Pinto
authors.forename: M
authors.initials: M
authors.lastname: Elberg
authors.forename: S
authors.initials: S
authors.lastname: Araneda
authors.forename: C
authors.initials: C
authors.lastname: Herzog
authors.forename: L
authors.initials: L
authors.lastname: Calabran
authors.forename: J
authors.initials: J
authors.lastname: Aguiló
authors.forename: M
authors.initials: M
authors.lastname: Ferrario
authors.forename: E
authors.initials: E
authors.lastname: Buckel
authors.forename: J A
authors.initials: JA
authors.lastname: Fierro
mesh_terms: D000208:Acute Disease; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000077552:Basiliximab; D002677:Chile; D003141:Communicable Diseases / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D056724:Immunity, Humoral / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007518:Isoantibodies / Q000097:blood; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015375:Receptors, Interleukin-2 / Q000037:antagonists & inhibitors*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D015375:Receptors, Interleukin-2; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab