title: Acute Rejection Clinically Defined Phenotypes Correlate With Long-term Renal Allograft Survival.
abstract: BACKGROUND
  Classification of acute rejection (AR) based on etiology and timing may provide a means for enhancing therapeutic results and allograft survival. This study evaluated graft and patient survival after the first AR episodes among kidney transplant recipients with an early or late antibody-mediated rejection (AMR), acute cellular rejection (ACR) or mixed AR (MAR).
  
  
  METHODS
  A prospective institutional review board-approved database was queried to identify biopsy-proven first AR episodes occurring from January 2005 to October 2012. The ACR was defined by Banff criteria; borderline AR was excluded. The AMR was defined as 3 of 4 criteria: renal dysfunction, donor specific antibody, C4d positivity on biopsy, and histological changes. The MAR met criteria for both ACR and AMR. Early AR occurred within six months post-transplant. AR episodes were then assigned to 1 of the 6 categories--early AMR, early ACR, early MAR, late AMR, late ACR, and late MAR.
  
  
  RESULTS
  One hundred eighty-two kidney transplant recipients identified with a first AR episode. Mean follow-up was 773 days (± 715 days). No difference was observed in patient survival. Death-censored graft survival was 84%. Death-censored graft loss was higher with late versus early AMR (P = 0.01) and late versus early ACR (P = 0.03), but not late versus early MAR (P = 0.3).
  
  
  CONCLUSIONS
  The AR type demonstrated a hierarchy for graft survival with ACR better than MAR better than AMR, which persisted for both early and late AR. Improvement in long-term results of AR may require development of specific treatment for individual AR types.
authors: 1 Houston Methodist Hospital, Houston, TX. 2 Division of Transplantation, Department of Surgery, University of Cincinnati Academic Health Center, Cincinnati, OH. 3 University of Cincinnati Medical Center, Cincinnati, OH. 4 The Christ Hospital, Cincinnati, OH. 5 Kidney and Hypertension Center, The Christ Hospital, Cincinnati, OH.
authors: Jill C
authors: JC
authors: Krisl
authors: Rita R
authors: RR
authors: Alloway
authors: Adele Rike
authors: AR
authors: Shield
authors: Amit
authors: A
authors: Govil
authors: Gautham
authors: G
authors: Mogilishetty
authors: Michael
authors: M
authors: Cardi
authors: Tayyab
authors: T
authors: Diwan
authors: Bassam G
authors: BG
authors: Abu Jawdeh
authors: Alin
authors: A
authors: Girnita
authors: David
authors: D
authors: Witte
authors: E Steve
authors: ES
authors: Woodle
mesh_terms: D000328:Adult; D001706:Biopsy; D015935:Complement C4b / Q000737:chemistry; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000737:chemistry; D010641:Phenotype; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d