title: Early versus late acute antibody-mediated rejection in renal transplant recipients.
abstract: BACKGROUND
  Over the last decade, the diagnostic precision for acute antibody-mediated rejection (aABMR) in kidney transplant recipients has improved significantly. The phenotypes of early and late aABMR may differ. We assessed the characteristics and outcomes of early versus late aABMR.
  
  
  METHODS
  Between January 1, 2005 and December 31, 2010, aABMR was diagnosed in 67 grafts in 65 kidney recipients, with a median follow-up of 3.6 years (range, 61 days-7.3 years). Recipients were stratified by early aABMR (<3 months after transplantation; n=40) and late aABMR (>3 months after transplantation; n=27). The main outcome was kidney allograft loss. Outcome of aABMR was compared with recipients with acute early (n=276) or late (n=100) non-ABMR during the same period.
  
  
  RESULTS
  Recipients with late aABMR had significantly reduced graft survival compared with recipients with early aABMR (P<0.001, log-rank test; 40% vs. 75% at 4 years; hazard ratio, 3.72; 95% confidence interval, 1.65-8.42). Graft survival in late aABMR was also inferior to late non-ABMR acute rejections (P=0.008). At transplantation, more patients were presensitized to human leukocyte antigens (22 [55%] vs. 4 [15%] in the early vs. late aABMR group). The late aABMR group was characterized by younger recipient age (37.9 ± 12.9 vs. 50.9 ± 11.6 years; P<0.001), increased occurrence of de novo donor-specific antibodies (52% vs. 13%; P=0.001), and nonadherence/suboptimal immunosuppression (56% vs. 0%; P<0.001).
  
  
  CONCLUSIONS
  Compared with early aABMR, late aABMR had inferior graft survival and was characterized by young age, frequent nonadherence, or suboptimal immunosuppression and de novo donor-specific antibodies.
authors: Department of Transplant Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway. christina.dorje@rikshospitalet.no
authors: Christina
authors: C
authors: Dörje
authors: Karsten
authors: K
authors: Midtvedt
authors: Hallvard
authors: H
authors: Holdaas
authors: Christian
authors: C
authors: Naper
authors: Erik H
authors: EH
authors: Strøm
authors: Ole
authors: O
authors: Øyen
authors: Torbjørn
authors: T
authors: Leivestad
authors: Tommy
authors: T
authors: Aronsen
authors: Trond
authors: T
authors: Jenssen
authors: Linda
authors: L
authors: Flaa-Johnsen
authors: Jørn Petter
authors: JP
authors: Lindahl
authors: Anders
authors: A
authors: Hartmann
authors: Anna Varberg
authors: AV
authors: Reisæter
mesh_terms: D000208:Acute Disease; D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000453:epidemiology
chemical_list: D007166:Immunosuppressive Agents; D007518:Isoantibodies